Subglottic cysts: The Great Ormond Street experience in 105 patients
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Subglottic cysts: The Great Ormond Street experience in 105 patients P. F. D. Bowles1 · J. Reading1 · D. Albert1 · R. Nash1 Received: 4 June 2020 / Accepted: 24 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The aim of the study was to assess the contemporary presentation and management of subglottic cysts and make recommendations on the treatment of these patients. Methods Retrospective case series of 105 patients between October 1999 and November 2017 from a paediatric teaching hospital. Results Ninety-one percentage (n = 96) had a history of prematurity, with a mean gestation of 27.2 weeks (SD ± 4.1). A history of intubation was found in 99% (n = 104) of cases [median 18 days (range = 1–176)]. Presenting symptoms were: Stridor 57.1%, (n = 60), difficult intubation 14% (n = 15), recurrent croup 11.4% (n = 12), failed extubation 7.6%, (n = 8), hoarseness/ weak cry 10.5% (n = 10). Ninety percentage (n = 94) underwent intervention for management of SGCs with 86% (n = 81) treated with cold steel marsupialisation and 14% (n = 13) with CO 2 laser. Recurrent cysts occurred in 56% (n = 53) of cases. Treatment modality did not affect recurrence (p = 0.594 Δ). Sixty-six percentage (n = 69/105) of patients had one or more concurrent airway pathology at MLB. Most frequent was subglottic stenosis 47% (n = 49), with 16% (n = 8) subsequently requiring open reconstructive airway surgery. Mean duration of follow-up was 47.6 months (SD ± 38.3). Conclusion SGC are an uncommon, reversible cause of upper airway obstruction and should be considered in the list of differential diagnoses in patients with a history of prematurity and perinatal intubation, presenting with stridor. While concurrent SGS is common, adequate symptom improvement in such cases may be achieved with SGC removal alone. Management is by surgical marsupialisation. Recurrence and additional airway pathologies are common and may necessitate longer-term treatment in centres with paediatric airway expertise. Keywords Subglottic cysts · Subglottic stenosis · Paediatric · Airway · Stridor · Larynx
Introduction Subglottic cysts (SGCs) are an uncommon, benign cause of airway obstruction. While the aetiology has been categorised as congenital or acquired, SGCs have a distinct pathogenesis to congenital laryngeal and saccular cysts. SGCs are superficial, or submucosal, and retention cysts thought to occur as a result of fibrosis and scarring following trauma from endotracheal intubation, leading to obstruction of Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00405-020-06321-z) contains supplementary material, which is available to authorized users. * P. F. D. Bowles [email protected] 1
Department of Otolaryngology, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK
submucosal mucus gland ducts and cyst formation in the neonatal airway [1, 2]. Symptoms may range from simple noisy breathing to stridor, respir
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