Holmium Laser as a Definitive Single-Modality Treatment for Severe Subglottic Stenosis in an infant: A Case Report

Introduction: Subglottic stenosis (SGS) is a pathological narrowing of the airway within the subglottic region, situated just below the vocal cords. This condition can cause significant respiratory compromise, ranging from dyspnea to life-threatening hypoxemia. While SGS may be congenital or acquired, the acquired form is more prevalent and is most frequently iatrogenic. Prolonged endotracheal intubation or tracheostomy are common causes, with post-intubation SGS accounting for approximately 90% of acquired cases in the pediatric population. Case Presentation: A 45-day-old male infant presented with a history of biphasic stridor and recurrent acute respiratory infections. Diagnostic bronchoscopy identified a Myer-Cotton grade III subglottic stenosis. The lesion was successfully managed in a single procedure using a Holmium laser via a rigid bronchoscope. At the seven-month follow-up, the infant remained in good health with no respiratory complications. Discussion The Holmium laser has been established as a viable pediatric tool, with applications in excising tracheal granulomas, webs, and stenoses, as well as in managing other pathologies such as hemangiomas and bronchogenic cysts. Its technical profile is particularly advantageous for the delicate pediatric airway. The laser is hydrophilic, touch-triggered, and characterized by a minimal thermal injury zone of 0.5–1.0 mm, which helps to minimize collateral damage. While many authors recommend adjunctive cryotherapy post-ablation to reduce the risk of restenosis, this was not employed in the present case. Conclusion Management of pediatric SGS typically requires a multi-modality approach. However, this case demonstrates that the Holmium laser can serve as a definitive single-modality treatment, even in very young infants with severe (Myer-Cotton grade III) stenosis. The patient showed no evidence of restenosis and maintained excellent respiratory function at the seven-month follow-up.