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Acquired total (grade 4) subglottic stenosis in children
L M Gustafson1, B E Hartley, R T Cotton
1Department of Otolaryngology-Head and Neck Surgery, Children's Hospital Medical Center, Cincinnati, Ohio 45267-0528, USA.
Insights
Surgical management of pediatric subglottic stenosis (SGS) has improved outcomes. Cricotracheal resection (CTR) shows a higher decannulation rate compared to laryngotracheal reconstruction (LTR) for severe SGS.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Surgery
- Respiratory Medicine
Background:
- Pediatric acquired total subglottic stenosis (SGS) presents significant management challenges.
- Management strategies have evolved over 25 years, necessitating outcome evaluation.
Purpose of the Study:
- To evaluate surgical management and outcomes for children with grade 4 SGS.
- To compare the effectiveness of different surgical techniques for treating severe SGS.
Main Methods:
- Retrospective study of 56 pediatric patients with acquired grade 4 SGS (1981-present).
- Analysis of causes, procedures performed, and decannulation rates.
- Comparison of outcomes between cricotracheal resection (CTR) and laryngotracheal reconstruction (LTR) with costal cartilage grafting (CCG).
Main Results:
- 44 out of 56 patients (79%) were decannulated.
- Decannulation rates improved from 67% (1980s) to 86% (1990s).
- CTR demonstrated a higher decannulation rate (92%) versus LTR with CCG (81%) and required fewer additional procedures (18% vs. 46%).
Conclusions:
- Advances in surgical techniques have improved decannulation rates for pediatric grade 4 SGS.
- Cricotracheal resection (CTR) appears to be a more effective primary surgical approach than laryngotracheal reconstruction (LTR) with CCG for achieving decannulation and reducing the need for revision surgeries.
Abstract:
Pediatric acquired total subglottic stenosis (SGS) is a challenging problem. The management of these patients has evolved at our institution over the past 25 years. We conducted a retrospective study to evaluate the surgical management and outcomes of children with grade 4 SGS. Fifty-six patients have presented with acquired grade 4 SGS since 1981. The causes included previous surgery (34), prolonged intubation (15), bums (1), and unknown causes (6). Of the 56 patients, 44 (79%) were decannulated; 120 total procedures were performed, and 39 patients (70%) required more than 1 procedure for decannulation. The decannulation rate has risen from 67% in the 1980s to 86% in the 1990s. Patients who underwent cricotracheal resection (CTR) had a higher decannulation rate than patients who underwent laryngotracheal reconstruction (LTR) with anterior and posterior costal cartilage grafting (CCG) (92% versus 81%), and were less likely to need additional open procedures to achieve decannulation (18% versus 46%). The decannulation rate for children with grade 4 SGS has improved because of advances in surgical technique. Currently, the principal operations used at our institution are 1) CTR and 2) LTR with anterior and posterior CCG. There was a trend toward a higher decannulation rate in patients who underwent CTR, and they were less likely to require further reconstructive surgery before decannulation.