2021 Volume 57 Issue 1 Pages 10-17
Purpose: Subglottic cysts (SGCs) can cause respiratory distress after tracheal intubation. We reviewed the diagnostic strategy, treatment and outcome of our patients with SGCs.
Methods: We retrospectively investigated the cases of six patients with SGCs treated at our hospital between January 2018 and December 2019.
Results: Five of our patients (83%) were born prematurely (median gestational age, 28 weeks; median birth weight, 991 g). All the patients had a history of tracheal intubation during the neonatal period (median duration: 11 days). At diagnosis, the median age was five months, and the median weight was 4.5 kg. Typical symptoms were retractive breathing, cyanosis, recurrent croup, and stridor. We performed rigid bronchoscopy on all the patients, and the severity of their airway obstruction was assessed by Myer–Cotton classification; three were in Grade I and three were higher than Grade II. All the patients except one Grade I patient required surgical treatment with cold instruments. For three patients, we used a micro-suction needle to puncture the cysts. Two of these three had recurrent cysts and required additional surgical treatment. For another two patients, we used a microknife and biopsy forceps for marsupialization, and neither have had recurrence so far.
Conclusions: Rigid bronchoscopy was useful in the diagnosis of SGCs in our patients and in the assessment of the severity of airway obstruction. Surgical treatment is necessary if a patient with SGCs shows respiratory symptoms, regardless of the size of the cysts. Puncture is a simple procedure and especially suitable for emergency situations, whereas marsupialization is a definitive procedure with a decreased risk of recurrence.
