Surgical Treatment for Laryngotracheal Stenosis in the Pediatric Patient

Abstract

We report our experience with laryngotracheal stenosis (LTS) in children during the last 12 years. Documentation and follow-up were available for 115 patients who underwent surgery for acquired or congenital LTS. Most were severe cases according to Cotton's classification. Forty-six weighed less than 10 kg at the time of surgery; 45 had pure congenital subglottic stenosis; 70 had acquired subglottic stenosis, mainly due to endotracheal intubation. The surgical techniques used have been various. The three main types of procedure were castellated laryngotracheoplasty, anterior cartilage rib grafting, and anterior and posterior cricoid cuts with or without grafting. All cases but 1 (44/45) of congenital subglottic stenosis have been successfully decannulated, 7 requiring a second procedure. The decannulation rate for acquired SGS was 89% (62/70), but 14 patients required multiple procedures. Current trends in subglottic stenosis management in our institution are presented.

Airway Measurement Using Morphometric Analysis

“…Application of this system can lead to accurate diagnosis of airway size preoperatively as recommended by Narcy et aI, 2 Silver et al, 9 and Zalzal. 13 Bronchoscopy is also applied postoperatively for follow-up ofsurgical interventions.b?…”

Carbon Dioxide Laser Serial Microtrapdoor Flap Excision of Subglottic Stenosis

“…with tracheotomy maintained secondary to additional cardiopulmonary problems. In the remaining six patients, a total of 20 endoscopie procedures were performed, 14 using the microtrapdoor flap technique, for an average of 3.3 procedures per patient. The severity of subglottic stenosis was graded as Cotton grade 2 in two patients, with the remainder characterized as Cotton grade I.9…”

Long-term quality of life in children after balloon dilatation for subglottic and tracheal stenosis: Eight years’ experience

“…Incorporating qualitative methods, such as semi-structured interviews or open-ended surveys, could provide a more comprehensive understanding of the lived experiences of children and their families posttreatment, as suggested by studies emphasizing the value of mixed-methods approaches in pediatric research. [ 18 ] To accurately differentiate SGS from other respiratory conditions presenting with similar symptoms, objective functional assessments have been the focus of several investigations. [ 19 ] These assessments aim to identify reliable diagnostic markers and inform treatment decisions, such as the need for surgical intervention.…”

“…[ 22 ] In contrast, open surgical approaches, such as laryngotracheal reconstruction or cricotracheal resection, are often reserved for severe or complex SGS cases but carry higher risks of complications, including vocal cord dysfunction, prolonged recovery, and significant scarring. [ 18 ] For instance, Narcy et al (1990) reported that OLR, while effective, can lead to postoperative complications in up to 20% of pediatric patients, including granulation tissue formation and airway compromise. [ 18 ] CO2 laser excision, another alternative, has been compared directly with balloon dilatation.…”

“…[ 18 ] For instance, Narcy et al (1990) reported that OLR, while effective, can lead to postoperative complications in up to 20% of pediatric patients, including granulation tissue formation and airway compromise. [ 18 ] CO2 laser excision, another alternative, has been compared directly with balloon dilatation. Erlandsson et al (2023) found no significant differences in treatment intervals between balloon dilatation and CO2 laser excision, suggesting comparable short-term efficacy.…”