Complications of Pediatric Laryngotracheal Reconstruction: Prevention Strategies

Abstract

A retrospective chart review was performed to quantify the postoperative complications and outcomes of 82 consecutive cases of laryngotracheal reconstruction (LTR) and cricotracheal resection (CTR) performed at a pediatric tertiary care hospital over the last 9 years. Six cases of respiratory syncytial virus (RSV) bronchiolitis and 8 cases of cervical pseudomonal wound abscess (PWA) were identified in a total of 12 patients. All of these infections occurred after single-stage LTR or CTR. Both RSV bronchiolitis and PWA were associated with significantly more unexpected days of intubation and admission to the intensive care unit, as well as higher rates of failure of LTR. Ossification of the cricoid cartilage, grade IV subglottic stenosis, and untreated gastroesophageal reflux disease (GERD) were also associated with restenosis. Trisomy 21 did not significantly influence the success rate of pediatric LTR. Both RSV bronchiolitis and PWA are potentially preventable complications of pediatric LTR and CTR. We propose strategies to prevent these infections. We also advocate the treatment of GERD during the healing phase of LTR.

Complications in paediatric airway management

“…The complications of laryngotracheal reconstruction are listed in Table 2 [26,27]. Patient selection is of extreme importance.…”

Thyroid alar cartilage graft in paediatric laryngotracheal reconstruction

“…Other authors have not clearly indicated the cause of LTR failure. Ludemann [23] described one case of partial necrosis with graft prolapse and two cases of graft infection after auricular graft usage, as being responsible for LTR failure. Silva [9] reported one case (2.1%) of partial graft necrosis with extrusion after an auricular cartilage graft.…”

“…A few studies [22,23] have demonstrated the role of infection in mucosal and cartilage necrosis. Sasaki's study [22] demonstrates that a bacterial level greater than 10 5 per gram of subglottic tissue could be responsible of chronic mucosal ulceration and chondritis.…”

Repair of incarcerated inguinal hernia in an infant with acute viral bronchiolitis

“…This seems to be particularly important in the case of complex procedures, such as open heart surgery and major airway reconstruction. [3][4][5] The exact period that surgery must be postponed must take into account the nature and urgency of the surgery, any other comorbidities and the presence of any ongoing symptoms or abnormal physical signs.…”

“…The surgical infant facing major cardiac or airway reconstructive surgery may be screened for RSV and surgery postponed in the face of a positive test. [3][4][5] There is no benefit, however, in conducting routine RSV testing for less complex surgery in asymptomatic patients. 17 High risk infants may be protected during the RSV season with palivizumab, a form of passive immunoprophylaxis.…”