Partial cricotracheal resection for pediatric subglottic stenosis: a single institution's experience in 60 cases.

Monnier, Ph.; Lang, Florian; Savary, M

doi:10.1007/s00405-002-0465-y

Cited by 70 publications

(48 citation statements)

References 6 publications

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“…Management options for laryngotracheal stenosis include open surgery and endoscopic methods [1][2][3][4][5][6][7][8][9]. A thorough preoperative assessment, including an evaluation of the patient's general condition and comorbiditiy, together with speciWc diagnostic procedures is decisive in the adequate choice of treatment.…”

Section: Introductionmentioning

confidence: 99%

Laryngotracheal stenosis and restenosis. What has the influence on the final outcome?

Jović

Dragičević

Komazec

et al. 2012

Eur Arch Otorhinolaryngol

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The aim of this study is to analyze the impact of various parameters on the course and treatment outcome in patients with laryngotracheal stenosis and recurrent stenosis. Two groups of patients were compared: Group I included 29 patients with primary stenosis, and Group II included 22 patients with recurrent stenosis. The most frequent etiological factor for the development of stenosis was prolonged endotracheal intubation (79.3:77.3%), with subglottic-tracheal (44.8:45.5%) and tracheal (48.3:36.4%) localization being the most affected. Subglottic-tracheal stenosis was more common in men. There were no significant differences between the groups in regard to the grade of lumen obstruction and the length of the resected segment. In male patients, the length of the resected stenotic segment was significantly longer. Subglottic-tracheal stenoses were longer than tracheal ones. Various surgical procedures were performed, with additional management of recurrent laryngeal nerve paralysis, if necessary. Laryngotracheal reconstruction (LTR) with costal cartilage grafting (CCG) was statistically significantly more often performed in Group II, while cricotracheal resection (CTR) was more common in Group I. The incidence of complications in Group I was 24.1%, and in Group II it was 31.8%. Satisfactory airway lumen with undisturbed breathing was achieved in 93.1% of patients in Group I, and in 95.3% in Group II. Since the success rate was similar in both groups of the patients, it could be concluded that treatment outcome depends less on the factors associated with the stenosis, and more on adequate choice of surgical procedure and surgical team know-how.

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Section: Introductionmentioning

confidence: 99%

Laryngotracheal stenosis and restenosis. What has the influence on the final outcome?

Jović

Dragičević

Komazec

et al. 2012

Eur Arch Otorhinolaryngol

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“…Diese Angaben stammen aus Zentren, die überwiegend mit der Cotton-Technik arbeiten bzw.gearbeitet haben.Sollte sich die PCTR nach Monnier gerade für die hochgradigen Stenosen noch stärker durchsetzen,ist mit einer weiteren Verbesserung der primären Erfolgsergebnisse zu rechen, denn die jüngsten Erfolgsquoten nach krikotrachealer Resektion liegen in Abhängigkeit von der Ausgangssituation zwischen 70 und 97% [17,30].…”

Section: Prognoseunclassified

Management von Postintubationsstenosen bei Kindern

Schultz-Coulon

2004

HNO

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Extubation difficulties after long-term endotracheal intubation in neonates and infants require immediate re-intubation with a somewhat thinner endotracheal tube, continuation of long-term intubation for another 7-14 days with antibiotic and antiphlogistic therapy including antireflux treatment as well as a subtile endoscopic examination. A tracheostomy is not indicated before several attempts of extubation have failed. An anterior cricoid split should be indicated with great care and in premature neonates only. In manifest cicatrical stenoses, subtile endoscopic diagnostics are an essential prerequisite for the choice of surgical method and time of surgery. In rather mild stenoses (grade II), laryngotracheal reconstruction (LTR) with anterior wall cartilage grafting is presently regarded as method of choice. For subglottic stenoses of higher degrees (grade III and IV), partial cricotracheal resection (PCTR) is felt to be the most successful procedure. For all scarred stenoses involving the glottic level, LTR with posterior and anterior wall cartilage grafting appears to be the only suitable treatment. LTR with anterior wall grafting only as well as the PCTR can be performed as a single stage procedure with postoperative long-term intubation on an intensive care unit for one or more days. LTR with posterior and anterior wall grafting requires long-term stenting for several weeks or months depending upon the individual condition. For long-term stenting, our so-called double-tube-technique using a modified Montgomery T silicon tube together with a perforated tracheal cannula has proved to be the safest and least irksome technique.

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“…In young children the narrow subglottis often became edematous during the surgery, so decannulation can be done only after a couple of days. Monnier applied laryngo-tracheal stents for weeks in severe cases, and finally his decannulation rate was 93% (62). According to our experiences no stent application is required.…”

Section: Pediatric Airway Surgery For Laryngo-tracheal Stenosesmentioning

confidence: 98%

“…As reconstruction an end-to-end anasthomosis of the first normal tracheal ring with the cricoid plate posteriorly and the inferior border of the thyroid cartilage anteriorly is made. If the stenosis spreaded anteriorly straight up to the level of the glottis, according to Monnier's concept a partial inferior midline thyreotomy up to the level of the anterior commissure (without transsectting it) is performed (62,82). The inferior border of the thyroid cartilage may be spreaded apart.…”

Section: Partial Crico-tracheal Resectionmentioning

confidence: 99%

“…According to the literature laryngo-tracheal reconstruction (LTR) (61) is the most accepted method for Grade I, II and III. Severe, Grade III and IV cases require partial cricotracheal resection (PCTR) (61,62,63). In childhood the anatomical properties, the lower size of the airways made these operation really difficult and demanding for the patients.…”

Section: Pediatric Airway Surgery For Laryngo-tracheal Stenosesmentioning

confidence: 99%

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Morphometric studies and a complex airway evaluation panel for objective and reliable assesment of laryngo-tracheal stenosis surgery

Sztanó¹

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Partial cricotracheal resection for pediatric subglottic stenosis: a single institution's experience in 60 cases.

Cited by 70 publications

References 6 publications

Laryngotracheal stenosis and restenosis. What has the influence on the final outcome?

Laryngotracheal stenosis and restenosis. What has the influence on the final outcome?

Management von Postintubationsstenosen bei Kindern

Morphometric studies and a complex airway evaluation panel for objective and reliable assesment of laryngo-tracheal stenosis surgery

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