Anterior and Posterior Cartilage Graft Dimensions in Successful Laryngotracheal Reconstruction

Abstract

To describe the dimensions of cartilage grafts used for successful laryngotracheal reconstruction, with the goal of establishing appropriate sizes for "off-theshelf" tissue-engineered cartilage grafts.Design: A retrospective review of prospectively maintained operative illustrations of a single surgeon's experience. Setting: Two tertiary children's hospitals. Patients: A consecutive sample of 54 patients (tracheotomized or intubated) with a diagnosis of subglottic stenosis. Interventions: Each patient underwent anterior (n=30), posterior (n=3), or anterior and posterior (n=22) laryngotracheal reconstruction. Rib cartilage was used in 51 patients and thyroid cartilage was used in 3 patients. Main Outcome Measure: Successful or failed extubation.Results: Of the 54 patients, 48 (89%) were successfully decannulated. The mean ± SEM length of the anterior graft was 20.7±10.3 mm, and the mean width of the anterior graft was 7.7±2.5 mm. The mean length of the posterior graft was 13.9±2.9 mm, and the mean width of the posterior graft was 4.2±0.9 mm. Conclusions:With the prospect of tissue-engineered cartilage implants becoming available for laryngotracheal reconstruction, the most appropriate templates for designing these implants should be based on the geometric dimensions of grafts carved from native tissues in cases that have been successfully decannulated. Based on our analysis, the use of 2-mm increments for the posterior grafts suggests a set of molds that are 2, 4, and 6 mm wide and 22 mm long. Using 2 ϫ 2-mm increments for the anterior grafts indicates that 36 mold sizes will be sufficient for 90% of predicted cases.

Balloon‐Assisted Rib Graft Placement in Endoscopic Posterior Cricoid Split Procedure

“…It included 24 patients with posterior grafts (mean age ± SD was 6.3 ± 6.6 years). The mean width of the posterior graft size was 4.2 ± 0.9 mm 5 …”

Age-related difficulty in post-intubation tracheal stenosis reconstruction: a comparative analysis of CO2-laser, resection and anastomosis, and costal cartilage grafting techniques

“…In addition, as can be expected, the airway that continues to develop during early childhood is the most important challenging factor, while the viability of CCG transferred at older ages is more important. In similar studies by Younis et al [17] (n = 46) and Koltai et al [18] (n = 54) including children who underwent laryngotracheal reconstruction using CCG, the age was not analyzed as a factor for failure. In these studies, success rates were reported as 89% and 83%, respectively.…”

“…However, despite these successful results, in almost half of the patients, some additional procedures are required in addition to the primary treatment for a patent airway and decannulation success [1,2,16]. Laryngotracheal grafting techniques are relatively preferred in high airway stenosis (close to the glottis), in cases where resection and anastomosis are not suitable, in patients with neck defects, and in the pediatric population [15,17,18].…”

Predicting Maximal Costal Cartilage Graft Size for Laryngotracheal Reconstruction

“…[1][2][3][4] Rib width is especially important when placing a posterior graft to achieve the appropriate amount of distraction while preserving sturdy flanges. 12 Although rib donor cartilage has not historically been a limiting factor, as more complex reconstructions and revision surgery after previous rib cartilage grafts become more common, volumetric data will be of increasing importance. We sought to determine the most appropriate rib for costal cartilage graft LTR using CT imaging of 25 children and measuring the dimensions of ribs 4 to 7 on 3D reconstructed coronal and sagittal scans.…”

“…Rib length is especially important when placing both anterior and posterior grafts, and for repair of long laryngeal clefts 1–4 . Rib width is especially important when placing a posterior graft to achieve the appropriate amount of distraction while preserving sturdy flanges 12 . Although rib donor cartilage has not historically been a limiting factor, as more complex reconstructions and revision surgery after previous rib cartilage grafts become more common, volumetric data will be of increasing importance.…”