Outcomes in Management of Pediatric Laryngotracheal Stenosis: Our Experience

Abstract

Background: Pediatric laryngotracheal stenosis is a difficult entity encountered in clinical practice which manifests with a myriad of etiologies and presentations. Management of pediatric laryngotracheal stenosis is a surgical challenge which requires meticulous preoperative evaluation and planning. Aim of study:This is a retrospective study of the efficacy of different surgical techniques involved in restoring the airway patency in pediatric laryngotracheal stenosis performed at our institution over 4 years. Materials and methods:Twenty-four pediatric patients underwent treatment for laryngotracheal stenosis over a 4-year period (June 2006-May 2010). Various surgical modalities, such as anterior cricoid split, costal cartilage interposition, stenting, laser procedures, etc. were used. Hood's stent, Montgomery T-tube, silastic swiss roll, indwelling nitinol tracheal stent were used to stent the airway after resection of the stenotic segment.Results: Nine patients achieved successful decannulation with single-stage procedure and 14 patients underwent multiple procedures. Of 24 patients, decannulation was possible in 18 patients (75%), one patient had no indication for tracheostomy and five children (20%) have a persisting tracheostomy including two who were lost to follow-up. Conclusion:It is vital to outline a rational approach to the management of laryngotracheal stenosis in children based on the site and severity of the stenotic segment. No single approach is ideal and often several procedures may be required before decannulation can be achieved. Limitations of study:Patients were followed-up for 1 year. A long-term follow-up is preferable.

Larynx stenosis; a challenge for the ENT surgeons

“…This approach is more effective than open approach in early stages of stenosis when the stenosis tissue is soft and flexible. Success rates in the cases is 66 to 80% (3)(4)(5).…”

“…The most frequent cause of subglottic dyspnea is internal trauma caused by tracheal intubation followed by infectious diseases, congenital and inflammatory pathology. Subglottic stenosis can be complicated by extension to multiple sites of the larynx or trachea, usually severe, caused by trauma or in systemic disease evolution (2,3). The symptoms of LS depend on age, morbidities, life-style of the patient as well as extension.…”

“…There are cases in which due to minimal LS orotracheal intubation can be difficult as in children with Down syndrome. In general, congenital stenosis are less severe than acquired LS (3). Voice evaluation must be included in the primary evaluation of a patient with LS.…”

Challenges in the Management of Laryngeal Stenosis

“…The next common presentation is combined or multiple site stenosis than involvement of supraglottis and glottis independently. [2] Evaluation of a case of LS includes fibreoptic laryngoscopy followed by direct laryngoscopy and bronchoscopy. Imaging with a high resolution CT scan of the larynx and trachea is important in evaluation of severe cases of LS with complete stenosis in whom direct evaluation is not possible, in patients with cartilage loss, those with associated injuries to trachea and oesophagus and in planning of open surgical treatment procedures.…”

“…The surgical interventions can be endoscopic or open depending on the type, site and severity of stenosis [1,2,4]. Endoscopic methods include mechanical dilatation, excision with cold steel or CO2 laser excision and balloon dilatation.…”