Bronchoscopic Laser Ablation for Subglottic Stenosis

Abstract

Background: Subglottic stenosis (SGS) is a serious condition in children, defined by narrowing of the airway below the vocal cords. Post-intubation injury is the most common acquired cause, particularly in patients with prolonged or traumatic intubation. While open surgical approaches are available, minimally invasive bronchoscopic techniques are increasingly preferred due to reduced morbidity and shorter recovery times.
Methods: We present a one-year-old boy who developed post-intubation SGS after treatment for severe RSV pneumonia. Following discharge, he exhibited persistent stridor and noisy breathing. Flexible bronchoscopy confirmed Cotton-Myer Grade II SGS, prompting consideration of minimally invasive intervention. The patient underwent diode laser ablation delivered through flexible bronchoscopy. This method was selected for its ability to precisely remove fibrotic scar tissue while minimizing damage to the surrounding mucosa and cartilage. The procedure was performed under continuous endoscopic visualization to ensure optimal restoration of airway patency.
Results: The intervention resulted in significant improvement in the airway lumen and reduction in stridor. The child tolerated the procedure without complications. Scheduled follow-up bronchoscopies were planned to monitor for recurrence and to guide further management if necessary.
Conclusion: Flexible bronchoscopy with diode laser therapy is a safe and effective minimally invasive option for treating post-intubation SGS in young children. This technique may help avoid more invasive surgical procedures, including tracheostomy, and plays an important role in multidisciplinary airway management.