Endoscopic recannulation with temporary steroid-eluting biodegradable stenting as a bridge strategy for complete subglottic stenosis in a child with CHARGE syndrome.

Abstract

Complete (Cotton-Myer grade IV) subglottic stenosis (SGS) is a severe form of airway obstruction traditionally managed with open airway reconstruction. Children with CHARGE syndrome frequently present with complex airway abnormalities and medical comorbidities that may complicate airway management and increase surgical risk.We report the case of a toddler with CHARGE syndrome who developed complete SGS following prolonged neonatal intubation and multiple failed extubation attempts. Given the patient's complex medical condition and high risk for open airway reconstruction, an endoscopic approach was pursued at 21 months of age. The stenotic segment was recannulated using a needle-guided technique followed by cold steel incision and balloon dilation. A temporary mini-PROPEL steroid-eluting biodegradable stent was placed adjunctively across the recannulated segment.Follow-up endoscopy demonstrated maintenance of airway patency without significant granulation tissue. The patient subsequently underwent successful single-stage laryngotracheal reconstruction and remained tracheostomy-free.This case demonstrates that complete subglottic obstruction may be amenable to endoscopic recannulation. In medically fragile children, temporary biodegradable steroid-eluting stenting may serve as a minimally invasive bridge to definitive airway reconstruction.