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Introduction and aim: To identify the different techniques for the endoscopic treatment of idiopathic subglottic stenosis (iSGS) and to review the obtained treatment results. Material and methods: Embase and Cochrane Library were searched for publications on endoscopically treated iSGS. Interventions included procedures with cold knife, dilation (rigid or balloon) or laser (CO2 or Nd:YAG), used in several combinations and supplemented with mitomycin C and/or corticosteroids. Primary endpoint was time interval between successive endoscopic procedures. Secondary endpoints were rate of stenosis recurrence, amount of endoscopic interventions per patient, tracheotomy rate and rate of open surgery. Results: Eighty-six abstracts were reviewed and fifteen articles, with 862 pooled patients, were included in the analysis. Mean sample size was 57 subjects and mean age was 47 years (range 36 – 54 years). Rate of stenosis recurrence ranged from 40% to 100%, with a weighted mean of 68%. Mean amount of interventions per patient varied between 1.8 and 8.28, with a weighted mean of 3.67. Time interval between interventions ranged from 2 months to 21 months, with a weighted mean of 12 months. Tracheotomy rate varied between 0% and 26%, with a weighted mean of 7%, and rate of open surgery varied between 0% and 27%, with a weighted mean of 10%. Single modality CO2 lasering showed highest rate of recurrence, highest amount of interventions per patient and shortest time interval between interventions. Combined techniques generated overall better outcomes. Conclusions: For endoscopic treatment of iSGS, a multitude of different endoscopic techniques and various combinations are currently being used, all with a high rate of recurrence but low morbidity. Consequently, endoscopic management is a valuable primary treatment but open surgery (cricotracheal resection) does still have an important role in the iSGS management, especially in cases with multiple recurrences after endoscopic treatment.

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Objectives: To review early clinical manifestations of Pierre Robin sequence (PRS) and their management during the first year of life in the University Hospitals Leuven. Methods: Retrospective series of 48 patients with PRS born between 2001 and 2011 and treated at a tertiary referral hospital. Review of the current literature about management of respiratory and breathing difficulties in the early life of PRS patients. Results: Of our cleft palate patients 15.3% presented with PRS. A syndrome was diagnosed in 14.6%, associated anomalies without a syndromic diagnosis in 56.3% and isolated PRS in 29.2% of the cases. Mortality rate directly related to PRS was 2.1%. Respiratory difficulties were observed in 83.3% and feeding difficulties in 95.6% of the patients. Respiratory problems were addressed in a conservative way in 75%, in a non-surgical invasive way in 42.5% and in a surgical way in 12.5%. A statistically significant relationship between the association of a syndrome or other anomalies, and a higher need for resuscitation and invasive treatment were found (chi-square test, p-values = 0.019 and 0.034). Feeding difficulties were managed conservatively in 91.3%, invasively in 80.4% and surgically in 15.2%. Conclusions: PRS is frequently associated with other abnormalities or syndromes. Therefore routine screening for associated anomalies in neonates with PRS is recommendable. Respiratory and feeding complications are highly frequent and possibly severe, particularly in patients with associated anomalies or syndromes, and should be recognized and addressed appropriately in an early stage. There is a potential role for the nasopharyngeal airway in reducing the need for the more traditional surgical interventions for respiratory problems