Partial cricotracheal resection for congenital subglottic stenosis in children: The effect of concomitant anomalies

George, Mercy; Ikonomidis, Christos; Jaquet, Yves; Monnier, Philippe

doi:10.1016/j.ijporl.2009.03.023

Cited by 17 publications

(20 citation statements)

References 26 publications

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“…Because of the above‐mentioned difficulties, a definitive surgical solution is usually delayed for years, although an early tracheostomy is often unavoidable . The most common surgical solutions (CTR/ECTR, PCTR, LTR) are recommended in general from the age of 1 year . The youngest PCTR patient described was a 1‐month‐old infant without any comorbidity .…”

Section: Discussionmentioning

confidence: 99%

“…However, even though the overall decannulation rate after CTR is over 80% ‐ the rate of reoperation is between 4–41%, depending on the grade of the stenosis and the comorbidities. The rate of reoperation is between 22–45% after LTR …”

Section: Discussionmentioning

confidence: 99%

“…[21][22][23][24] The most common surgical solutions (CTR/ECTR, PCTR, LTR) are recommended in general from the age of 1 year. 4,11,14,15,[21][22][23][24][25][26][27] The youngest PCTR patient described was a 1-month-old infant without any comorbidity. 22 However, even though the overall decannulation rate after CTR is over 80% -the rate of reoperation is between 4-41%, depending on the grade of the stenosis and the comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…Congenital subglottic stenosis (SGS) is the third most common congenital laryngeal anomaly after laryngomalacia and vocal fold paralysis, however this is the most common laryngeal anomaly necessitating tracheostomy in children less than 1 year of age . Congenital SGS amounts to 5% of the laryngotracheal stenosis, but its true incidence is difficult to assess due to the high incidence of intubation in patients with preexisting narrow subglottic airway or other significant comorbidities . The prenatal diagnosis of subglottic stenosis is not routinely possible.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Congenital SGS amounts to 5% of the laryngotracheal stenosis, but its true incidence is difficult to assess due to the high incidence of intubation in patients with preexisting narrow subglottic airway or other significant comorbidities. [3][4][5][6] The prenatal diagnosis of subglottic stenosis is not routinely possible. Severe dyspnea at birth requires urgent intubation followed by tracheotomy to allow adequate ventilation and oxygenation of the newborn.…”

Section: Introductionmentioning

confidence: 99%

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Slide laryngotracheoplasty for congenital subglottic stenosis in newborns and infants

et al. 2019

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Objectives Subglottic stenosis is the most common laryngeal anomaly necessitating tracheostomy in early childhood. Crico‐ and laryngotracheal resection and laryngotracheal reconstruction—usually with autologous cartilage graft implantation—are the most effective treatments. These surgical techniques are obviously challenging in neonatal age and infancy. However, a reconstructive surgery performed at early age may prevent the sequel of complications. Methods The authors present their novel surgical method for congenital subglottic stenosis. Seven infants had inspiratory stridor; two of them had to be intubated and one required tracheostomy. Laryngotracheoscopy, CT or MRI revealed subglottic stenosis: Cotton‐Myer grade II in one, and grade III in six cases. Slide laryngotracheoplasty was performed before 5 months of age (10–130 days), with a follow‐up period of average 36 months (4–80 months). Phoniatry and quality of life questionnaire were used for evaluation of postoperative results. Results Slide laryngotracheoplasty in the neonatal age made the temporary tracheostomy unnecessary. All babies remained intubated for 3 to 10 days with an uncuffed tracheal tube. After extubation, no dyspnea or swallowing disorder occurred. A subjective quality of life questionnaire, laryngotracheoscopy, clinical growth charts showed satisfactory functional results. Conclusions Single‐stage slide laryngotracheoplasty might be a favorable solution for subglottic stenosis, even in early childhood. In one step, the airway can be maintained without stenting and tracheostomy. Level of Evidence 4 Laryngoscope, 130:E199–E205, 2020

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Slide laryngotracheoplasty for congenital subglottic stenosis in newborns and infants

et al. 2019

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Congenital Malformations of the Cricoid Cartilage: Upper Airway Obstruction and Treatment Strategy

2023

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ObjectivesTo review treatment and outcomes in patients with congenital cricoid cartilage malformation.MethodsRetrospective analysis of patients with diagnosis of congenital cricoid malformation (CCM) treated in a single tertiary pediatric referral center between 1985 and 2022. Patients were grouped according to the morphology of the cricoid cartilage that was diagnosed during endoscopy. We reviewed the treatment strategy(s), decannulation rate, complications, and functional outcomes.ResultsTwenty‐nine patients were grouped into four morphological subtypes of cricoid cartilage: 10 patients had a hypoplastic cricoid, eight had an elliptic shape, five had severe anterior thickening, and six an accentuated V‐shape posterior cricoid plate. Twenty‐four patients underwent surgery, and five were closely followed up without surgical treatment. Eight patients had a tracheostomy prior to surgery, and the majority had a hypoplastic cricoid. Most patients (20 out of 24) required additional procedures postoperatively to achieve an age‐appropriate airway. Thirteen patients needed endoscopic dilatation(s) and granulation tissue removal; four needed more aggressive treatment, and three patients required revision open surgery. Decannulation was achieved after a median of 4.5 months in all previously tracheostomized patients. Endoscopy at the last follow‐up showed an age‐appropriate airway in 27 patients; 20 patients had normal oral feeding, and 11 patients had a normal voice.ConclusionEndoscopy is important to diagnose CCM and most of the time patients would need only watchful waiting. In this report, surgery was required for patients who continued to remain symptomatic and had a compromised airway. The type of surgery depends on the type of cricoid malformation and the grade of stenosis.Level of Evidence4 Laryngoscope, 2023

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

2023

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ObjectivesOutcome measures of revision open airway surgery in pediatric laryngotracheal stenosis (LTS) are reported.MethodsData on 46 pediatric LTS patients undergoing revision open airway surgery were collected retrospectively. The measured outcomes were decannulation rate, time to decannulation, postoperative complications, additional surgery to achieve decannulation, and functional results.ResultsThe most common revision surgery was partial cricotracheal resection (PCTR) in 21/46, followed by extended PCTR (ePCTR) in 20/46, and laryngotracheal reconstruction (LTR) in 5/46 patients. A 90.7% overall decannulation rate (ODR) and a 74.4% operation‐specific decannulation rate (OSDR) were achieved. Delayed decannulation was identified in children aged 5 years or less (p = 0.038) and in patients with previous primary open airway surgery (p = 0.039). Complications were observed in 52.2% of patients. To achieve optimal airway patency, additional open or endoscopic airway surgeries were necessary in 30.4% and 47.7% of patients, respectively. Age 5 years or less (p = 0.034), multiple comorbidities (p = 0.044), revision ePCTR (p = 0.023), and laryngeal stenting (p = 0.018) were risk factors requiring additional open surgery to achieve age‐appropriate airway. Failed primary open airway surgery (p = 0.034) and comorbidities (p = 0.044) were risk factors for a higher rate of additional endoscopic surgeries. Postoperatively 63.0% of patients achieved normal breathing, 82.2% were dysphonic and 91.1% were orally fed.ConclusionsIn this report, the patient's age under 5 years, previous primary open airway surgery, medical comorbidities, and laryngeal stenting had a significant negative impact on revision open airway surgery outcomes.Level of EvidenceLevel 4 Laryngoscope, 2023

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Partial cricotracheal resection for congenital subglottic stenosis in children: The effect of concomitant anomalies

Cited by 17 publications

References 26 publications

Slide laryngotracheoplasty for congenital subglottic stenosis in newborns and infants

Slide laryngotracheoplasty for congenital subglottic stenosis in newborns and infants

Congenital Malformations of the Cricoid Cartilage: Upper Airway Obstruction and Treatment Strategy

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

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