Update on the use of auricular cartilage in laryngotracheal reconstruction

The pediatric otolaryngologist is often called upon to aid in the diagnosis and management of subglottic stenosis. This report contains an update of our experience using auricular cartilage in laryngotracheal reconstruction. A retrospective review of the medical records at St Louis Children's Hospital identified 43 children with subglottic stenosis. Thirty-one children were treated by use of auricular cartilage with a success rate of 84%, and an overall 94% success rate after revision surgery. Eight children in whom an anterior cricoid split initially failed were secondarily treated with auricular cartilage with a success rate of 75%. Two children initially treated with costochondral cartilage underwent multiple reconstructive procedures with either auricular cartilage or costochondral cartilage with an overall success rate of 50%. The remaining 2 children had long-segment tracheal stenosis and underwent repair with auricular cartilage with a 50% success rate. We find that auricular cartilage grafts are highly effective when used in a primary single-stage procedure in children with grade I or II stenosis. We have had limited success with auricular cartilage in patients with grade III stenosis and are reluctant to use it in grade IV stenosis, long-segment tracheal stenosis, staged reconstruction, or revision of an auricular or costal cartilage graft laryngotracheal reconstruction.