Airway and Swallowing Outcomes Following Laryngotracheoplasty With Posterior Grafting in Children

Abstract

Objectives/Hypothesis: Evaluate swallowing and airway outcomes following laryngotracheoplasty with posterior grafting (LTP PCCG).Methods: Retrospective review of pediatric patients undergoing LTP PCCG from 2016 to 2019 at a tertiary care pediatric hospital. We included demographics, indications, approach, and revision status. We evaluated preoperative and postoperative instrumental and functional swallow evaluations, and we also gathered information on airway outcomes.Results: Thirty-one patients were included in the study. Median (interquartile range [IQR]) age was 4.0 (2.0, 7.0) years old. Primary indication for surgery was bilateral vocal cord immobility (BVCI) in 11 (35.5%) and posterior glottic stenosis (PGS) in 20 (64.5%). Mean (standard deviation) length of follow-up was 11.0 (8.3) months. Twelve patients had gastrostomy tubes (GT) before surgery, and no patients required placement of GT after surgery. Of the remaining 19 patients, 6 required nasogastric feeding for >4 weeks (average length 1.8 months, longest 3.5 months). At last follow-up, 25 (80.6%) patients were primarily orally fed. Eighteen patients had tracheotomies prior to surgery. No patients without a tracheostomy required placement of tracheostomy before or after surgery and only 1 patient had a tracheostomy at last follow-up. Average time to decannulation was 3.7 months, with surgery-specific success of 87.1% and overall success of 96.8%. Four (12.9%) patients required a major intervention to achieve decannulation.Conclusion: LTP PCCG is an effective surgical technique to address PGS and BVCI with high decannulation rates. It may cause temporary swallowing dysfunction, but in this series a majority of children were orally fed at last follow-up.

Revision surgery for laryngotracheal stenosis in children: A single center's 44 years experience

“…Moderate dysphonia was the most common voice outcome in 40.0% (18/45) of patients. Similar to previous reports in children after posterior laryngeal grafting, 22 our results show that most (41/45, 91.1%) patients achieved safe oral feeding postoperatively.…”

“…Primary airway surgery results have been thoroughly reported, but the outcomes of revision airway surgery remain largely unknown 4–7,10,13,17,22–25 . Distortion and instability of the laryngeal framework, lack of healthy mucosa and limitations of further airway resection are some of the issues encountered in revision airway surgeries 13,14,22 …”

“…Additional endoscopic or open surgeries were necessary to achieve decannulation in 47.7% (21/44) and 30.4% (14/46) of our patients, respectively. In comparison, half of the primary open surgeries are reportedly followed by additional endoscopic treatments 13,14,22 …”

“…[4][5][6][7]10,13,17,[22][23][24][25] Distortion and instability of the laryngeal framework, lack of healthy mucosa and limitations of further airway resection are some of the issues encountered in revision airway surgeries. 13,14,22 Revision surgery has been recommended at least 6 months following a failed primary surgery 17 and the reported average interval between surgeries is 2 to 4 years. 13,24 Nevertheless, almost half (22/46, 47.8%) of our patients were less than 5 years of age and the median age at revision surgery was 5.6 years.…”

“…Primary airway surgery results have been thoroughly reported, but the outcomes of revision airway surgery remain largely unknown. [4][5][6][7]10,13,17,[22][23][24][25] Distortion and instability of the laryngeal framework, lack of healthy mucosa and limitations of further airway resection are some of the issues encountered in revision airway surgeries. 13,14,22 Revision surgery has been recommended at least 6 months following a failed primary surgery 17 and the reported average interval between surgeries is 2 to 4 years.…”