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Cricotracheal resection for pediatric subglottic stenosis
1Department of Otolaryngology, Head and Neck Surgery, University Hospital CHUV, Lausanne, Switzerland. philippe.monnier@chuy.hospvd.ch
Insights
Cricotracheal resection (CTR) is a safe and effective treatment for severe pediatric subglottic stenosis. This procedure offers better outcomes than laryngotracheoplasties, with high decannulation rates and normal laryngeal growth.
Area of Science:
- Pediatric Otolaryngology
- Surgical Innovation
- Airway Reconstruction
Background:
- Severe subglottic stenosis in children poses significant management challenges.
- Cricotracheal resection (CTR) was historically underutilized due to perceived risks like anastomotic dehiscence and recurrent laryngeal nerve injury.
- Pediatric subglottic stenosis often requires complex airway management strategies.
Purpose of the Study:
- To evaluate the safety and efficacy of cricotracheal resection (CTR) for severe subglottic stenosis in pediatric patients.
- To assess outcomes including decannulation rates, airway patency, and laryngeal growth.
- To compare CTR with alternative surgical techniques like laryngotracheoplasties.
Main Methods:
- A cohort of 38 infants and children with severe subglottic stenosis (Grades III and IV) underwent partial cricoid resection with primary thyrotracheal anastomosis.
- Preoperative tracheotomy dependence and referral status were documented.
- Surgical outcomes, including decannulation, recurrent laryngeal nerve function, airway symptoms, and laryngeal growth, were assessed postoperatively.
Main Results:
- Decannulation was successful in 36 out of 38 patients.
- No recurrent laryngeal nerve injuries or fatalities were observed.
- All patients demonstrated normal laryngeal and tracheal growth, with most experiencing no exertional dyspnea.
Conclusions:
- Cricotracheal resection (CTR) is a highly effective and safe surgical option for severe pediatric subglottic stenosis.
- CTR yields superior results compared to laryngotracheoplasties for severe cases.
- CTR should be considered the primary treatment for severe (Grades III and IV) subglottic stenosis in children.
Abstract:
Until recently, cricotracheal resection (CTR) has not been commonly accepted as a treatment modality for severe subglottic stenosis in the pediatric age group. The reasons have included the risk of a possible dehiscence at the site of the anastomosis, the likelihood of injury to the recurrent laryngeal nerves, and the interference with normal growth of the larynx. Thirty-eight infants and children with a severe subglottic stenosis underwent a partial cricoid resection with primary thyrotracheal anastomosis. Thirty-three patients were tracheotomy-dependent at the time of surgery and 34 were referred cases; 27 were classified as grade III, and 10 as grade IV stenoses according to new Cotton's classification. Nineteen patients were younger than 3 years of age at the time of surgery. The tracheotomy was resected during the surgical procedure in 21 cases. Decannulation was achieved in 36/38 cases after an open procedure. There is one complete restenosis and one good result awaiting decannulation after further surgery for a Pierre Robin syndrome. The authors experienced no lesion of the recurrent laryngeal nerves and no fatality. Thirty-one patients show no exertional dyspnea, three a slight stridor while exercising, and two patients are not decannulated. The postoperative follow-up in longer than 10 years in eight cases. All patients show a normal growth of the larynx and trachea. Compared to laryngotracheoplasties, CTR gives better results for severe subglottic stenosis. This operation should become the treatment of choice for severe (grade III and IV) subglottic stenosis in infants and children.