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Introduction <p>Subglottic stenosis (SGS) is a pathological narrowing of the airway within the subglottic region, situated just below the vocal cords. This condition can cause significant respiratory compromise, ranging from dyspnea to life-threatening hypoxemia. While SGS may be congenital or acquired, the acquired form is more prevalent and is most frequently iatrogenic. Prolonged endotracheal intubation or tracheostomy are common causes, with post-intubation SGS accounting for approximately 90% of acquired cases in the pediatric population.</p> Patient presentation <p>A 45-day-old male infant presented with a history of biphasic stridor and recurrent acute respiratory infections. Diagnostic bronchoscopy identified a Myer-Cotton grade III subglottic stenosis. The lesion was successfully managed in a single procedure using a Holmium laser via a rigid bronchoscope. At the seven-month follow-up, the infant remained in good health with no respiratory complications.</p> Discussion <p>The Holmium laser has been established as a viable pediatric tool, with applications in excising tracheal granulomas, webs, and stenoses, as well as in managing other pathologies such as hemangiomas and bronchogenic cysts. Its technical profile is particularly advantageous for the delicate pediatric airway. The laser is hydrophilic, touch-triggered, and characterized by a minimal thermal injury zone of 0.5–1.0&#xa0;mm, which helps to minimize collateral damage. While many authors recommend adjunctive cryotherapy post-ablation to reduce the risk of restenosis, this was not employed in the present case.</p> Conclusion <p>In contrast to the more frequent multi-modality treatment approach in cases of pediatric subglottic stenosis, our case suggests that the Holmium laser, as a single-modality intervention, could be sufficient for a short-term successful cure even in the youngest patients and with severe Myer-Cotton grades. Continued long-term objective surveillance with endoscopy is essential to monitor for any late recurrence.</p>

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Holmium laser as a single-modality treatment for severe subglottic stenosis in an infant

  • 期刊论文

  • 发表日期：

    2025年11月25日

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  • Naser El-Mefleh,
  • Mulham Jarjanazi,
  • Aya Nakwan,
  • Linah Kaf Alghazal

摘要

Introduction

Subglottic stenosis (SGS) is a pathological narrowing of the airway within the subglottic region, situated just below the vocal cords. This condition can cause significant respiratory compromise, ranging from dyspnea to life-threatening hypoxemia. While SGS may be congenital or acquired, the acquired form is more prevalent and is most frequently iatrogenic. Prolonged endotracheal intubation or tracheostomy are common causes, with post-intubation SGS accounting for approximately 90% of acquired cases in the pediatric population.

Patient presentation

A 45-day-old male infant presented with a history of biphasic stridor and recurrent acute respiratory infections. Diagnostic bronchoscopy identified a Myer-Cotton grade III subglottic stenosis. The lesion was successfully managed in a single procedure using a Holmium laser via a rigid bronchoscope. At the seven-month follow-up, the infant remained in good health with no respiratory complications.

Discussion

The Holmium laser has been established as a viable pediatric tool, with applications in excising tracheal granulomas, webs, and stenoses, as well as in managing other pathologies such as hemangiomas and bronchogenic cysts. Its technical profile is particularly advantageous for the delicate pediatric airway. The laser is hydrophilic, touch-triggered, and characterized by a minimal thermal injury zone of 0.5–1.0 mm, which helps to minimize collateral damage. While many authors recommend adjunctive cryotherapy post-ablation to reduce the risk of restenosis, this was not employed in the present case.

Conclusion

In contrast to the more frequent multi-modality treatment approach in cases of pediatric subglottic stenosis, our case suggests that the Holmium laser, as a single-modality intervention, could be sufficient for a short-term successful cure even in the youngest patients and with severe Myer-Cotton grades. Continued long-term objective surveillance with endoscopy is essential to monitor for any late recurrence.