Modifications of Airway Reconstruction in Children

• Published in: Annals of otology, rhinology & laryngology Vol. 107; no. 5; pp. 365 - 369
• Main Authors: Ward, Robert F., Rabkin, Dimitry, Gordon, Michael, April, Max M.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-05-1998; Annals Publishing Compagny; SAGE PUBLICATIONS, INC
• Subjects: Adolescent; Biological and medical sciences; Cartilage - transplantation; Child; Child, Preschool; Female; Follow-Up Studies; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Infant; Infant, Newborn; Intensive Care, Neonatal; Laryngostenosis - etiology; Laryngostenosis - surgery; Male; Medical sciences; Postoperative Complications - etiology; Respiration, Artificial - adverse effects; Retrospective Studies; Stents; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract; Suture Techniques; Trachea - surgery; Tracheal Stenosis - etiology; Tracheal Stenosis - surgery; Treatment Outcome; laryngotracheal reconstruction; reconstruction; stenosis; modifications; Human; Reconstruction; Pediatrics; Stenosis; Plastic surgery; Retrospective; Result; Respiratory tract; Costal cartilage; Treatment; Surgery; Classification; ENT disease; Graft; Larynx disease; Technique; Child; Subglottis
• ISSN: 0003-4894; 1943-572X
• DOI: 10.1177/000348949810700501

We review our treatment experience of subglottic stenosis in 66 children. Sixty-one of these children required some form of airway expansion using cartilage grafts. Eight children had grade I (Cotton classification), 15 grade II, 28 grade III, and 15 grade IV stenosis. AH patients with grade I and II lesions were decannulated. Ninety-three percent of grade III patients and 67% of grade IV patients were also ultimately decannulated. Laryngotracheal reconstruction with costal cartilage grafting has become widely accepted for treatment of severe laryngotracheal stenosis. Several modifications of this technique have been employed to treat our patients. Recently, we have used a modified single-stage technique with an endotracheal tube stent, externally secured for 1 week, to avoid postoperative intensive care unit admission for sedation and/or paralysis, and its related complications. Posterior graft design and placement without sutures was also performed in 20 cases. A two-surgeon technique that involves a simultaneous endoscopic control of incision of the stenotic area was employed. These modifications will be described in detail.