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1	Subglottic Stenosis What is it and how is it treated?
2	My goal today is to explain to you what subglottic stenosis is. Well, my 4^th child, Jessica, was born 13 weeks early and she had this life threatening condition for the first 3 years of her life.
3	Subglottic Stenosis means the “narrowing of the airway”. Grade I – less than a 50% obstruction of the airway. Grade II – a 51% to 70% obstruction of the airway. Grade III – a 71% to 99% obstruction of the airway Grade IV – Total obstruction of the airway
4	This is one view of what subglottic stenosis may look like in the windpipe (trachea):
5	"There are 2 types of..." There are 2 types of subglottic stenosis:
6	5% of the Acquired Subglottic Stenosis cases are caused by infection or chemical irritation.
7	Jessica
8	The initial step in treating a child with subglottic stenosis is to give the child a tracheostomy. A tracheotomy is an incision in the trachea (windpipe) that forms an opening so a tube can be inserted. The child is then able to breathe through the tube, instead of the mouth and nose, which they can’t do because of the obstruction in their airway.
9	The long term goal in treating subglottic stenosis is to enlarge the airway so that the child can breathe through their windpipe (trachea) and the trach tube can be removed. Subglottic Stenosis Grades I and II may be treated by dilating the airway or lasering the scar tissue away. This doesn’t always work and “MAJOR” surgery still may need to be performed. Subglottic Stenosis Grades III and IV require a throat reconstruction procedure called Laryngotracheoplasty or LTP. This procedure is most successful when it is performed on the child around age 3.
10	A brief overview of what an LTP consists of in very simple terms: A. Subglottic stenosis, anterior view, and cross section. B. Rib graft. C. Subglottic stenosis with rib graft interposition, anterior view and cross section.
11	"A tube called a stent..." A tube called a stent is then placed to help form the “new” airway. The stent is removed about 3 weeks later. Then you try capping the trach. This is when you cover the trach with a plug to see if the child can breathe out their mouth and nose. If that is successful… Decannulation – removal of the trach - is attempted.
12	As you can see: Jessica’s throat reconstruction on May 4^th, 2005 turned out WONDERFULLY!!! Our goal of getting her to breathe without the trach tube was reached on July 5^th, 2005.