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Long-term outcome of surgically treated acquired subglottic stenosis in infancy
R J Massie1, C F Robertson, R G Berkowitz
1Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Australia. massiej@cryptic.rch.unimelb.edu.au
Insights
Anterior cricoid split (ACS) surgery can help infants with severe subglottic stenosis (SGS) breathe easier. Successful ACS leads to excellent long-term outcomes, while failed ACS often requires tracheostomy and subsequent laryngotracheoplasty (LTP) with good results.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Surgical Outcomes Research
Background:
- Acquired severe subglottic stenosis (SGS) in infants presents significant airway challenges.
- Limited data exists on the long-term prognosis for infants requiring surgical intervention for SGS.
Purpose of the Study:
- To evaluate the long-term outcomes of infants with acquired severe subglottic stenosis (SGS) managed surgically.
- To compare outcomes between anterior cricoid split (ACS) and tracheostomy as primary airway management.
- To assess the effectiveness of laryngotracheoplasty (LTP) in patients with persistent SGS.
Main Methods:
- Retrospective review of 34 infants with acquired SGS treated between 1989-1997.
- Analysis of primary management (ACS or tracheostomy) and subsequent surgical interventions (LTP).
- Assessment of persistent symptoms (stridor, exercise limitation, infections, voice alteration) and lung function during follow-up.
Main Results:
- 12 infants successfully extubated after ACS showed excellent long-term outcomes with minimal residual symptoms.
- 9 infants failed ACS requiring tracheostomy; 17 underwent LTP with decannulation in 15 patients.
- LTP group showed good long-term outcomes, with few experiencing residual stridor or voice alteration, though airflow limitation persisted.
Conclusions:
- Anterior cricoid split (ACS) is effective for selected infants with severe acquired SGS, facilitating extubation and yielding excellent long-term results.
- Failure of ACS necessitates tracheostomy, but laryngotracheoplasty (LTP) offers a favorable long-term prognosis for airway reconstruction.
- Long-term follow-up indicates that surgical management of acquired SGS can lead to significant improvement in airway function.
Abstract:
There is little information about the long-term outcome of infants with acquired severe subglottic stenosis (SGS) who require surgical intervention. We retrospectively identified infants with acquired subglottic stenosis who required anterior cricoid split (ACS) or tracheostomy for primary airway management; some of these children later required laryngotracheoplasty (LTP). All children were treated at our hospital from 1989-1997. During follow-up, we assessed patients for persistent symptoms (stridor at rest, exercise limitation, difficulty with respiratory tract infections, recurrent croup, and voice alteration), and we measured lung function when possible. We identified 34 infants with acquired SGS: 13 treated primarily with tracheostomy, and 21 with ACS. Nine patients could not be extubated following ACS and required tracheostomy, while the 12 who were extubated were followed up at a mean time of 76 months postoperatively; 3 had moderate stridor at rest, 1 moderate exercise limitation, and none had recurrent croup. Four of 5 who had lung function measured had moderately severe extrathoracic airflow limitation. From the tracheostomy group (n = 13) and the failed ACS group (n = 9), 2 patients were decannulated without further surgery, 17 underwent LTP, and 2 have LTP planned. Fifteen of the 17 patients who had LTP have been decannulated. Follow-up, at a mean time of 58 months postoperatively, showed none with stridor at rest, 3 with moderate exercise limitation, none with recurrent croup, and 2 with moderate voice alteration. All 5 patients who had lung function measured had airflow limitation, 1 being severe. In conclusion, ACS facilitates extubation in selected patients with severe, acquired SGS of infancy, and the long-term outcome of patients successfully extubated is excellent. Failure of ACS invariably means tracheostomy, and subglottic repair by LTP is associated with a good long-term outcome.