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Published on: June 20, 2018
[Open surgical treatment of laryngo-tracheal stenoses in children]
1HNO-Klinik, Städtische Kliniken Dortmund. stkd.hno@dokom.net
Insights
Open surgical procedures offer a successful alternative for treating pediatric laryngo-tracheal stenoses when conservative or endoscopic methods fail. This approach, particularly resection surgery for severe cases, can lead to decannulation and improved outcomes for children.
Area of Science:
- Pediatric Otolaryngology
- Airway Surgery
- Pediatric Airway Stenosis Management
Background:
- Traditional treatments for pediatric laryngo-tracheal stenoses, including conservative management and endoscopic laser therapy, have yielded disappointing results.
- Tracheostomy in children presents significant parental burden and risks of cannula-related complications.
- There is a need for more effective surgical interventions for pediatric airway stenoses.
Purpose of the Study:
- To evaluate the efficacy of open surgical procedures for treating pediatric laryngo-tracheal stenoses.
- To compare outcomes of different open surgical techniques in this patient population.
Main Methods:
- A retrospective chart review was conducted on 22 children diagnosed with laryngo-tracheal stenoses.
- Patients ranged from two months to 15 years old at the time of surgery.
- Surgical procedures included laryngo-tracheal reconstruction with rib cartilage graft, crico-tracheal resection, and laryngofissure.
Main Results:
- The primary causes of stenosis were prolonged endotracheal intubation (12 cases) and congenital anomalies (3 cases).
- Seventeen children underwent laryngo-tracheal reconstruction, 3 had crico-tracheal resections, and 2 had laryngofissures.
- Five children were successfully treated without tracheostomy, and 13 of the 17 requiring tracheostomy were decannulated post-surgery.
Conclusions:
- Open laryngo-tracheal surgery is a successful treatment for pediatric airway stenoses, offering an alternative to endoscopic management for selected cases.
- Resection surgery is indicated for severe stenoses with significant scar tissue formation.
- Single-stage procedures avoiding tracheostomy are feasible with appropriate post-operative care and expertise.
Background:
Treatment strategy in laryngo-tracheal stenoses in children has for a long time been conservative treatment with tracheostomy or bougination in hope of a more or less spontaneous resolution of the stenosis during growth of the child. The results of this option as well as the endoscopic treatment with different laser systems has proved to be rather disappointing. A child with a tracheostomy means a heavy load for the parents to look after this child as well as a constant threat from complications by displacement or plugging of the cannula.
Method:
A retrospective chart review of 22 children, aged between two months and 15 years at the time of surgery with laryngo-tracheal stenoses treated by different open surgical procedures.
Results:
The aetiology of the stenoses was prolonged endotracheal intubation in 12 children, congenital stenoses in 3 children, unsuccessful laser treatment for acquired stenoses in 3 children, subglottic hemangioma in 3 children and a transglottic cyst in 1 child. 17 cases were treated by laryngo-tracheal reconstruction with rib cartilage graft, 3 crico-tracheal resections, and 2 laryngofissures. Five children could be treated without tracheostomy. From the remaining 17 cases 13 could be decannulated, 1 child died one week after surgery from his congenital heart disease. 3 children are still with a tracheostomy, two of them had had endoscopic laser therapy alio loco before.
Conclusions:
Open laryngo-tracheal surgery for paediatric airway stenoses is a successful treatment option besides endoscopic management for selected cases. Resection surgery seems to be indicated for severe stenoses with proliferative scar tissue formation. Depending on personal experience and post-operative facilities procedures without tracheostomy but prolonged post-operative intubation are possible single-stage-solutions.
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