Airway stenting with the LT-Mold™ for severe glotto-subglottic stenosis or intractable aspiration: experience in 65 cases

Abstract

The purpose of this study was to assess the safety and efficacy of stenting in upper airway reconstructions for benign laryngotracheal stenosis (LTS) with a newly designed prosthesis, the LT-Mold™. The LT-Mold and its proper use during open surgery and endoscopy are described, and the experience gathered from a prospectively collected database on 65 patients treated for complex LTS or severe aspiration is reported. This series is compared to the results of other stenting methods. All patients were available for evaluation. In all but one case, the prosthesis was removed at the end of the study. The new prosthesis did not induce any stent-related trauma to the supraglottis, glottis and subglottis. Before adding a distal round-shaped silicone cap to the LT-Mold, granulation tissue was usually seen at the stent-mucosal interface at the tracheostoma level. In 14 cases, there has been a spontaneous extrusion of the prosthesis through the mouth; this problem was solved by fixing the prosthesis through the reinforced portion of the prosthesis at the cap level and by adding one fixation stitch in the supraglottis. We have to document the loss of the silicone cap in three cases. This problem was resolved by designing a new prototype with an integrated cap, glued with a slow hardening silicone glue. Fifty-four (83 %) of 65 patients were decannulated after a mean duration of stenting of 3 months (range 1–12 months). The mean follow-up after decannulation was 23 months (range 1 month to 10 years). The experience gathered with the LT-Mold shows that long-term stenting for complex LTS is safely achieved when the prosthesis is used with its distal integrated silicone cap. The softness and smoothness of the prosthesis with a round-shaped configuration of both extremities help avoid ulceration and granulation tissue formation in the reconstructed airway. Adequate fixation is mandatory to avoid extrusion.

Experience with Transcordal Silicone Stents in Adult Laryngotracheal Stenosis: A Bicentric Retrospective Study

“…Stents were left in place for a mean duration of 6 months and no significant complications were reported. Finally, Alshammari and Monnier [19] published a prospective cohort of 65 patients, 53 of whom were of pediatric age, with BLTS who were treated with Easy-LT-Mold stents. Stents were used for postsurgical airway calibration again, but also after pure ET.…”

“…Transcordal stents represent an alternative to tracheostomy in this population when simple dilatation is insufficient. Transcordal stenting has previously been described mainly in patients with a tracheostomy complicated by recurrent aspirations as well as in the postoperative course of laryngotracheal surgeries, such as temporary splinting [17-19]. Very few patients with benign laryngotracheal stenosis (BLTS) have previously been treated with transcordal stenting [17-19].…”

Pediatric airway surgery

“…Currently, the LT-Mold (Bredam S.A., St. Sulpice, Switzerland), which was developed in Lausanne, is the most distinguished airway-prosthesis for pediatric patients. It is made of soft silicone and therefore avoids pressure necrosis and the formation of granulation tissue (39). The prosthesis was created molding pediatric cadaver larynges and therefore is adapted to anatomical features of the glottic and subglottic region.…”

Long‐term functional airway assessment after open airway surgery for laryngotracheal stenosis

“…Also, added endoscopic surgical procedures for a scarred glottis carries its own risk, and endotracheal stents have important disadvantages and complications such as infection, granulation tissue formation, stent migration, and even mortality. [19][20][21] Our study results clearly show the importance of the presence of comorbidities and its influence on functional outcome. This emphasizes the need for a multidisciplinary approach in these children in an attempt to optimize the overall health status, thus optimizing longterm outcome.…”

“…However, as long‐term objective outcome data are lacking in other studies, we cannot be sure which strategy has the best long‐term outcomes. Also, added endoscopic surgical procedures for a scarred glottis carries its own risk, and endotracheal stents have important disadvantages and complications such as infection, granulation tissue formation, stent migration, and even mortality …”