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Child with naso-gastric tube using sign language. Young girl aged 2 1/2 years with a permanent tracheostomy vent and a naso-gastric feeding tube, giving the sign for the letter 'a'. The child has a congenital subglottic stenosis (SGS) grade 3, a narrowing of the subglottic airway where it passes through the ring-shaped cricoid cartilage. Grade 3 indicates the blockage is between 50% and 99%. A tracheostomy tube has been inserted below the cricoid to allow normal breathing. However this is below the larynx so the child is unable to talk normally and uses sign language to communicate. The child is unable to swallow so must be fed by tube. Treatment of SGS is normally by surgery, either by splitting the cricoid and grafting inserts of cartilage or by resection of the trachea. Congenital SGS is realtively rare, but is the third most common congenital airway problem.
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