A Case of Severe Acquired Subglottic Stenosis With Glottic Involvement Treated With Triamcinolone Acetonide Injection and Laryngotracheal Reconstruction

Abstract

The management of severe acquired subglottic stenosis with glottic involvement is still a challenging problem. A girl of 2 years and 4 months of age with a history of failed extubation and tracheostomy presented with severe glottic and subglottic stenosis. We treated the glottic stenosis with several sessions of injection therapy with triamcinolone acetonide (TA), ahead of laryngotracheal reconstruction with anterior and posterior costal cartilage graft. Glottic and subglottic scar tissue gradually involuted owing to serial TA injection and it became possible to observe the subglottic lumen. We injected less than 1 mg/kg body weight of TA into the scar at a time at a weekly interval for 3 to 4 weeks; no specific complication was observed during the injection treatment. The T-tube stent was removed after 2 months and the tracheostomy opening was surgically closed 1 year and 3 months after the laryngotracheal reconstruction. Although the optimal injection method, injection interval and dosing have not been established, in this report, we suggest the potential efficacy of TA injection as a treatment choice.