Primary Cricotracheal Resection with Thyrotracheal Anastomosis for the Treatment of Severe Subglottic Stenosis in Children and Adolescents
- 1 January 2005
- journal article
- research article
- Published by SAGE Publications in Annals of Otology, Rhinology & Laryngology
- Vol. 114 (1), 2-6
- https://doi.org/10.1177/000348940511400102
Abstract
Severe subglottic stenosis in children is best managed by laryngotracheal reconstruction or cricotracheal resection (CTR). We describe clinical outcomes with CTR and end-to-end anastomosis in pediatric patients with severe subglottic stenosis in a tertiary-care pediatric teaching hospital in Mexico City. We prospectively followed up all consecutive patients younger than 18 years of age with a Myer-Cotton grade 3 or 4 subglottic stenosis who underwent CTR between May 1, 2000, and March 31, 2003. The frequency of each clinical outcome was calculated. Twenty-two patients (16 boys [72.7%] and 6 girls [27.3%]) were included. The mean age at operation was 4.6 years (range, 11 months to 16 years). Eighteen patients (81.8%) required primary CTR, and 4 (18.2%) required extended CTR. Seventeen (77.3%) had grade 3 stenosis, and 5 (22.7%) had grade 4 stenosis. Six (27.3%) had associated clinical conditions, and 3 (13.6%) had associated vocal cord mobility defects. All were tracheostomy-dependent at presentation, and none had undergone previous airway surgery. Ten (45.5%) underwent one-stage surgery, and 12 (54.5%) had a concomitant temporary tracheotomy. No intraoperative complications occurred. Seventeen patients (77.3%) developed postoperative granulation tissue requiring endoscopic resection. The mean follow-up was 1.2 years (range, 2 months to 2.8 years). No deaths occurred. Fifteen children (88.2%) with grade 3 stenosis and 5 (100%) with grade 4 stenosis were decannulated, for an overall decannulation rate of 90.9%. Partial cricoid resection with end-to-end anastomosis has been a feasible procedure with reproducible successful results among our patients. We conclude that CTR performed as a primary procedure is an effective treatment for the management of severe subglottic stenosis in children.Keywords
This publication has 27 references indexed in Scilit:
- Surgical Treatment of Laryngotracheal Stenosis: A Review of 60 CasesAnnals of Otology, Rhinology & Laryngology, 1998
- Pediatric laryngotracheal reconstruction with cartilage grafts and endotracheal tube stenting: The single‐stage approachThe Laryngoscope, 1995
- Partial cricoid resection with primary tracheal anastomosis for subglottic stenosis in infants and childrenThe Laryngoscope, 1993
- Auricular Cartilage Grafts in Laryngotracheal ReconstructionAnnals of Otology, Rhinology & Laryngology, 1993
- Treatment of Laryngotracheal Stenosis With Anterior and Posterior Cartilage Grafts: A Report of 41 ChildrenJAMA Otolaryngology–Head & Neck Surgery, 1993
- Single-Stage Laryngotracheal ReconstructionJAMA Otolaryngology–Head & Neck Surgery, 1991
- Update of the cincinnati experience in pediatric laryngotracheal reconstructionThe Laryngoscope, 1989
- Laryngeal Problems in ChildrenAnnals of Otology, Rhinology & Laryngology, 1987
- Schwann cell tumors of the facial nerveThe Laryngoscope, 1974
- Surgical Correction of Subglottic Stenosis of the LarynxAnnals of Otology, Rhinology & Laryngology, 1972