Outcomes of Holmium Laser, Cryoablation, and Budesonide Inhalation for Treating Severe Central Airway Stenosis in Infants

Figures & data

Figure 1. Holmium laser therapy for severe web-like stenosis. (A) Ablation performed by holmium laser probe in the center of membrane. (B) The area of airflow in the center of stenosis site was expanded after treatment. (C) Batch ablation by holmium laser at 3-4 spots at 12, 3, 6, and 9 o’clock.

Table 1. Patients’ demographic and clinical characteristics.

Variable	Total (n = 28)	Web-like stenosis (n = 16)	Scar contracture stenosis (n = 12)
Demography
Age at first treatment (months)	12.8 ± 8.8	11.1 ± 9.9	15.2 ± 5.9
Sex
Male	17 (60.7)	10 (58.8)	7 (41.2)
Female	11 (39.3)	6 (54.5)	5 (45.5)
Site of stenosis
Subglottic	15 (53.6)	8 (53.3)	7 (46.7)
Trachea	13 (46.4)	5 (38.5)	8 (61.5)
Level of severity
III	19 (67.9)	11 (57.9)	8 (42.1)
IV	9 (32.1)	5 (55.6)	4 (44.4)
Treatment modality
Balloon dilatation only	10 (35.7)	8 (80.0)	2 (20.0)
CO2 cryotherapy only	4 (14.3)	0 (0)	4 (100.0)
Balloon dilatation + CO2 cryotherapy	14 (50.0)	8 (57.1)	6 (42.9)
Outcome
Cured	13 (35.7)	10 (76.9)	3 (23.1)
Effective	13 (57.1)	5 (38.5)	8 (61.5)
Unsuccessful	2 (7.1)	1 (50)	1 (50)

Continuous data are presented as mean ± SD. Categorical data are presented as n (%).

Figure 2. The bronchoscope image of a 27-month-old boy with severe subglottic web-like stenosis. (A) Grade IV subglottic web-like stenosis. (B) Holmium laser ablation. (C) Balloon dilatation after airway expansion. (D) The morphology of subglottic airway after holmium laser ablation and CO₂ cryotherapy.

Figure 3. The bronchoscope image of a 15-month-old girl with severe pneumonia. Granulation and keloid proliferation at the site of tracheostomy. Severe subglottic scar contracture stenosis. (A) New granulation at the subglottic site of tracheostomy. (B-C) After expansion of airway airflow area, CO₂ cryotherapy was applied to freeze the left granulation and keloid tissues for debridement. (D) Subglottic airway image after holmium laser ablation and CO₂ cryotherapy.

Figure 4. Flowchart of endoscopic treatment for severe CAS in infants.