Subglottic stenosis following prolonged endotracheal intubation is most commonly due to pressure necrosis at which specific level of the tracheal/subglottic airway?

• A At the level of the glottis (true vocal cords)
• B At the cuff site of the endotracheal tube (usually tracheal rings 2–4)
• C At the tip of the endotracheal tube
• D At the cricoid cartilage level (subglottis) ✓

Explanation

Subglottic stenosis after intubation most commonly develops at the subglottic level (inferior border of the cricoid cartilage), where the circumferential rigid cricoid ring is in closest contact with the endotracheal tube. Pressure on the submucosal tissue causes ischemia, ulceration, and subsequent fibrosis/cicatrix formation, resulting in circumferential stenosis. The cricoid is the narrowest part of the pediatric airway. Cuff-related injury can cause tracheal stenosis at a lower level (rings 2–4) as a separate entity.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.