Laryngeal stenosis and laryngomalacia treated with a silicone stent in a prematurely delivered child: a case report

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Jurgita Borodičienė¹, Eglė Žukauskaitė², Matas Kalinauskas², Marius Kašėta³, Andrius Macas¹

¹ Department of Anesthesiology, Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009, Kaunas, Lithuania

² Faculty of Medicine, Academy of Medicine, Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009 Kaunas, Lithuania

³ Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Eiveniu str. 2, LT-50009, Kaunas, Lithuania

Abstract

Background. Preterm birth is one of the most significant risk factors for infants’ laryngeal stenosis (LS), which can occur as laryngomalacia (LM). LS can be defined as a partial or circumferential narrowing of the endolaryngeal airway and may be congenital or acquired. This condition cause various symptoms such as stridor, dyspnea and respiratory distress, therefore early intubation is required. Most of the patients with LS or LM outgrow their disease, but the rest of them need surgical help.

Objectives. The aim of this article is to present a successful surgical treatment for preterm infant with LS.

Methods: case presentation and an analysis of literature. Research of articles in “PubMed”, “Google Scholar” databases with keywords used as follows: “Laryngeal stenosis”, “Laryngomalacia”, “Pediatric stent”, “Premature delivery”, “Endolaryngeal microsurgery”.

Case presentation. 3-year-old male presented the hospital with diagnosed LM and for laryngeal stent insertion surgery. The patient was born at 26 gestational weeks and was treated for sepsis during the neonatal period, was intubated at birth because of severe respiratory distress, had 6 endolaryngeal microsurgeries (EM) and received Kenalog injections 5 times. Laryngeal stent was inserted during the last EM procedure. Patient undergone general anesthesia, the American Society of Anesthesiologists classification (ASA) was evaluated as III. The operation was successful without any complications. After three months the stent was removed and the patient’s difficulty of breathing regressed.

Conclusion. In respiratory distress caused by LM and LS an insertion of a stent can be as equally or more effective than laryngoplasty. Regression of the respiratory distress symptoms after removal of the stent is considered a successful outcome.

Keywords: laryngeal stenosis, laryngomalacia, pediatric stent, premature delivery, endolaryngeal microsurgery.