4 years old child presented with severe respiratory distress .Tracheostomy was done ,Mass was seen in subglottis.Removal done by cricoid split approach

1. Subglottic Polyp Causing Respiratory Distress In A
4 years old Child
Dr Shrikant Phatak
Head of ENT Department
Choithram Hospital & Research Center
Indore

2. Subglottic Polyp Causing Respiratory Distress In
A 4 years old Child
• A 4 years old male presented with gradually increasing
difficulty in breathing & speaking.
• On clinical examination child was afebrile, severely dyspnoeic
unable to speak.
• There was tachycardia, could maintain p02 of 80% only after
02 mask.
• Neck on auscultation was practically silent, air entry was very
much reduced bilaterally in the chest.
• A provisional diagnosis of subglottic foreign body was made

3. Subglottic Polyp Causing Respiratory Distress In
A 4 years old Child
• Blood counts were normal. An emergency Tracheostomy
under local anesthesia with minimal sedation with a stand by
anesthesiologist was planned as the endotracheal intubation
was not possible. A high risk consent was taken with the
anticipated apnea after opening the trachea due to wash out
of C02 drive.
• After tracheostomy endoscopy done under GA showed a large
subglottic mass.
• CT can was done. The mass was removed by cricoid split
approach by a vertical incision from above tracheostomy.
• Patient was decanulated 6 weeks post op after ensuring
patent supra stomal airway by X-Ray neck.

4. Subglottic Polyp Causing Respiratory
Distress In A 4 years old Child
Video Laryngoscopy under sedation. Red arrow
subglottic mass. Blue arrow available air way. Yellow
arrows vocal cords

5. Subglottic Polyp Causing Respiratory Distress In A 4
years old Child
Arrow showing Soft Tissue Opacity
Above Tracheostomy Sagittal View
Arrow showing Soft Tissue Opacity
Above Tracheostomy Coronal CT

6. Subglottic Polyp Causing Respiratory Distress In
A 4 years old Child
Mass being Exposed Opening Trachea
& Cricoid Split
Mass being Exposed Opening
Trachea

7. Subglottic Polyp Causing Respiratory Distress In
A 4 years old Child
Mass being Dissected
Mass being Separated
Completely

8. Subglottic Polyp Causing Respiratory Distress In
A 4 years old Child
Retrograde Endoscopy Through Trachea
After Removal of the Subglottic Mass
Video laryngoscopy intra op showing
incision in anterior wall

9. Subglottic Polyp Causing Respiratory Distress In
A 4 years old Child
Histopathology Microphotograph Histopathology Microphotograph

10. Subglottic Polyp Causing Respiratory Distress In A 4
years old Child
Third Post Operative Day

11. Subglottic Polyp Causing Respiratory Distress In
A 4 years old Child
Neck Just Before Decanulation Neck 2 months after discharge

12. Disclaimer
• The information contained in the presentation is based on the personal
experience and cases collected at Choithram Hospital Indore over the last
20 years.
• It is intended for the use of Medical students AnesthesiaENT& Pediatrics
post graduates.
• The views expressed are purely on personal opinion. viewers can make
their own opinion. For any confusion please contact sole author.
• Everybody is allowed to copy or download the material best suited to him.
I am not responsible for any controversies arising out of the presentation.
• For any suggestions or corrections you may please contact
phatak_shrikant@yahoo.in

13. Subglottic Polyp Causing Respiratory Distress In
A 4 years old Child
• Thank You