Microdebrider resection of acquired subglottic cysts: case series and review of the literature.

OBJECTIVE: Pediatric subglottic cysts (SGC) are a rare but curable cause of respiratory distress. Previous studies have described microsurgical marsupialization and carbon dioxide laser ablation to treat SGC. In this report we describe our experience performing endoscopic resection of SGC with a laryngeal microdebrider.

METHODS: A retrospective review of all patients who underwent endoscopic resection of SGC with a laryngeal microdebrider between January 2004 and October 2008 at a tertiary care children's hospital was performed.

RESULTS: Eight patients with one or more SGC were treated with microdebrider resection. All patients presented with stridor or respiratory distress, were born prematurely (mean gestational age 27 weeks), and had been intubated for between 1 and 91 days (mean 33 days). In all cases, suspension laryngoscopy was performed under general anesthesia. The SGC was visualized using a 4.0-mm Hopkins rod telescope and excised using a 2.9-mm diameter laryngeal microdebrider (skimmer blade). No patient experienced significant bleeding following excision. Mean surgical time was 36 min (range 26-59 min). Seven of eight patients (87.5%) were extubated by post-operative day 1. All patients had a follow-up bronchoscopy within 10 weeks. Six of eight patients (75%) had a single treatment, while two patients (25%) required a second resection. One patient had a symptomatic recurrence (12.5%). All eight patients are now free of disease with a mean follow-up of 21 months. No patient developed clinically significant scarring or subglottic stenosis.

CONCLUSIONS: The laryngeal microdebrider offers a safe and effective way to remove SGC with a low recurrence rate.