Pediatric endoscopic airway management with posterior cricoid rib grafting

Abstract

Objectives/Hypothesis: To confirm and extend reported successful treatment of posterior glottic stenosis in pediatric patients using endoscopic laser division of the posterior cricoid plate with augmentation using costal cartilage.Study Design: A retrospective chart review and case series. Methods: Medical records were examined to determine the surgical indications, outcomes, and postoperative complications of this procedure.Results: Twelve patients underwent the procedure, six females and six males, with an average age of 7 years (range, 2-26 years). There were 8/12 (67%) patients successfully decannulated after being tracheostomy dependent. There were no consistent anatomic abnormalities or surgical findings predictive of failure to decannulate. Average hospital stay was 3.6 days (range, 2-9 days). There were no deaths or other major complications; one patient had extrusion.Conclusions: Endoscopic posterior cricoid grafting is a valuable surgical option for patients with posterior glottic stenosis. The procedure is associated with low morbidity and permits decannulation in the majority of patients.

Endoscopic posterior graft laryngotracheal reconstruction – our initial experience of surgical technique in six children

“…The Inglis technique has been adopted by other authors with comparable outcomes to our series. The procedure is less effective in more severe grade 3–4 subglottic stenosis in which anterior and posterior grafting is required.…”

“…Utilising the laser can also be cumbersome and time‐consuming. Whilst some authors have used a temporary tracheostomy, this has not proven necessary in our patients.…”

Endoscopic Posterior Cricoid Split and Costal Cartilage Graft Placement in Children

“…8,9 Aspiration was not noted with the endoscopic approach in the previously reported series. [3][4][5] In our study, only 1 patient with transglottic stenosis had thin liquid aspiration issues that were present prior to and remained unchanged after EPCSCG.…”

“…10 Endoscopic posterior cricoid split and costal cartilage graft placement now is an additional less invasive option to accomplish posterior glottic and subglottic airway expansion. [3][4][5] Our experience with the use of EPCSCG in 16 patients with subglottic and transglottic stenosis illustrates that EPCSCG can be successfully used for select subglottic and transglottic lesions. Fourteen of the 16 patients in our series were successfully decannulated, with 1 patient requiring an additional open procedure (anterior graft) and 4 others undergoing more mild endoscopic manipulation.…”

Endoscopic posterior cricoid split with costal cartilage graft: A fifteen‐year experience

“…7 A subsequent, multi-institutional case series of 28 patients who underwent EPCS/RG included 9 patients with a diagnosis of BVFI. 6 Six of the patients with BVFI had a tracheotomy in place prior to the EPCS/RG procedure or during the perioperative period, and all 6 were subsequently decannulated. The remaining 3 patients never underwent tracheotomy.…”