Bioabsorbable Stenting in a Case of Severe Pediatric Posterior Glottic Stenosis

Abstract

Introduction:

Pediatric patients, especially those under 5 years of age, are at increased risk of laryngeal injury and subsequent posterior glottic stenosis (PGS) after prolonged or repeated intubations. Despite various surgical options, optimal management remains unclear, and restenosis is a common complication. Steroid-eluting stents, such as the Propel™, have shown promise in sinus applications but are underreported in airway stenosis and reconstruction.

Methods:

We present a case of a 2-year-old female with transverse myelitis and neuromuscular respiratory failure with bilateral vocal cord paresis, which led to multiple intubations and subsequent PGS. She ultimately underwent tracheostomy due to recurrent respiratory failure with viral infections and associated failure to thrive. Once stable, preparations for decannulation began. The patient underwent endoscopic division of posterior glottic scar tissue, followed by placement of a Propel™ steroid-eluting stent to the interarytenoid and arytenoid mucosa.

Results:

At 2-week follow-up, laryngoscopy revealed significant reduction in scar tissue without restenosis, with progressive resolution of granulation tissue and edema. Despite persistent vocal cord paresis, airway patency was maintained. At 3-month follow-up, there was marked improvement of stenosis sufficient to allow tracheostomy capping.

Conclusion:

This case highlights the off-label use of a steroid-eluting stent as adjunctive therapy in a pediatric patient with PGS. Outcomes demonstrated reduced scar tissue and improved airway patency, allowing progression toward decannulation. Further studies are needed to evaluate the role of steroid-eluting stents in the management of complex laryngeal disorders.