Partial upper airway obstruction occurring weeks or months after prolonged endotracheal intubation is an uncommon but well-recognized phenomenon and is usually secondary to fibrotic scarring and stenosis in the subglottic region. Three patients who were seen over a 12-month period with severe obstruction are reported. All were born at approximately 26 to 28 weeks' gestation and had required prolonged endotracheal intubation in the neonatal period. The cause of obstruction was cysts of the subglottic trachea.Case 1—A girl was delivered by breech extraction at 26 weeks' gestation following spontaneous labor and weighed 810 g. She was intubated immediately and received intermittent positive pressure ventilation for respiratory distress syndrome for 6 days. The nasotracheal tube remainedin situfor a total of 8 days. The patient subsequently developed bronchopulmonary dysplasia requiring supplemental oxygen for 57 days.At 15 weeks of age, the infant was readmitted with signs of an upper respiratory tract infection and subacute onset of marked inspiratory and expiratory stridor, tachypnea, and severe rib recession. A provisional diagnosis of subglottic stenosois was made. At direct laryngoscopy and bronchoscopy, the vocal cords and supraglottic region appeared normal, but three smooth-walled cysts, 2 to 3 mm in diameter, were visible immediately below the cords. These caused marked narrowing of the tracheal lumen and prevented advancement of a 2.5-mm bronchoscope.
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