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Managing a Subglottic Cyst in a Pediatric Patient: A Case Study at the 7th Annual Symposium

This case study, presented by Melissa M. Dziedzic APRN, CORLN, details the management of a 4-month-old patient, Solaris, with a persistent noisy breathing issue attributed to a right subglottic cyst. Despite trials of nebulized medications, symptoms persisted, necessitating diagnostic laryngoscopy and bronchoscopy. The cyst was excised, leading to significant postoperative improvement in Solaris's respiratory status. With careful follow-up, the child showed remarkable recovery, highlighting the importance of thorough evaluation and appropriate surgical intervention in pediatric airway management.

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Managing a Subglottic Cyst in a Pediatric Patient: A Case Study at the 7th Annual Symposium

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Presentation Transcript

  1. The Noisy Breather 7th Annual Pediatric Otolaryngology Symposium October 4, 2012 Melissa M. Dziedzic APRN, CORLN

  2. Meet Solaris

  3. History • Presented at 4 mos with a h/o noisy breathing since birth • Parents describe a “stridorous sound” on inspiration and expiration • +Retractions; color pink; gaining weight; feeds vigorously; occasional vomiting (on Prevacid) • On Budesonide and Albuterol via nebulizer without an improvement • Several office and ER visits for her noisy breathing

  4. Past Medical History • Normal pregnancy without complications • Born at 30 wks gestation requiring 2 mos in the NICU for ventilatory support and then CPAP • Heart Murmur at birth resolved without further intervention

  5. Physical Examination • Mild inspiratory and expiratory stridor • Mild intercostal retractions • No nasal flaring • Color is pink and extremities are warm with brisk capillary refill • Chest is clear with transmitted inspiratory and expiratory upper airway sounds

  6. Diagnostic Laryngoscopy

  7. Right Subglottic Cyst

  8. Right Subglottic Cyst

  9. Subglottic Cyst • Ductal Cysts arise from the blockage of submucosal glands which can occur in the vallecula, subglottis, or vocal cords • Subglottic cysts are common after prolonged intubation d/t irritation and blockage of the submucosal glands

  10. Treatment Plan • Allow Solaris to feed and grow and have her return in 3 months • Follow-up visit 3 months later>doing well • 2 months later>admitted for pneumonia with increased stridor and respiratory distress • Plan to expedite surgical excision of the right subglottic cyst with a diagnostic laryngoscopy and bronchoscopy to further evaluate the airway • Developed respiratory distress and increased stridor-surgery planned for that evening

  11. Diagnostic Laryngoscopy and Bronchoscopy • Using a rigid telescope the oral cavity, oropharynx, hypopharynx, and supraglottic and glottic larynx was evaluated • Diagnosed with a large cystic mass on the right posterior half of the vocal cord that extended below the level of the glottis • Rigid bronchoscopy – no abnormalities below the level of the glottis

  12. Excision of Right Subglottic Cyst

  13. Excision Right Subglottic Cyst

  14. Excision of Right Subglottic Cyst

  15. Postoperative Care • Post operative observation in the PICU • Placed on Steroids • Kept intubated overnight • Extubated the next day but kept on O2 • O2 d/c’d the next day, but increased WOB>received racemic epi • Improved overnight>to regular pedi floor • Discharged the next day

  16. Postoperative Follow-Up • 1 month later-remarkable improvement *no further stridor *no nebulizer treatments *feeding and growing well • Pathology Report *fibrous tissue partially lined with respiratory type mucosa • 3 months later-Diagnostic Laryngoscopy Clear

  17. Easy Breathing!

  18. Questions?

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