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Partial cricotracheal resection for pediatric subglottic stenosis: a single institution's experience in 60 cases
1Department of Otolaryngology and Head and Neck Surgery, University Hospital, CHUV, 1011 Lausanne, Switzerland. Philippe.Monnier@chuv.hospvd.ch
Insights
Partial cricotracheal resection (PCTR) successfully decannulated 95% of infants and children with severe subglottic stenosis (SGS). This surgical approach offers a high success rate for airway reconstruction in pediatric patients.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Respiratory Medicine
Background:
- Severe subglottic stenosis (SGS) poses significant challenges in pediatric airway management.
- Surgical intervention is often necessary for SGS cases that do not respond to conservative treatments.
Purpose of the Study:
- To evaluate the efficacy of partial cricotracheal resection (PCTR) with primary thyrotracheal anastomosis in treating severe SGS in infants and children.
- To determine the decannulation rates and identify factors influencing outcomes in this patient cohort.
Main Methods:
- A retrospective study of 60 infants and children with severe SGS (Myer-Cotton grades II-IV) who underwent PCTR.
- Surgical technique involved primary thyrotracheal anastomosis.
- Patient outcomes were assessed based on decannulation status, restenosis, and need for further interventions.
Main Results:
- Of 60 patients, 57 (95%) were successfully decannulated.
- One patient experienced complete restenosis.
- Decannulation rates varied by surgical approach: 97% for primary PCTR, 100% for salvage PCTR, and 70% for extended PCTR.
Conclusions:
- PCTR with primary thyrotracheal anastomosis is a highly effective surgical treatment for severe subglottic stenosis in pediatric patients.
- The procedure demonstrates a high success rate for decannulation, with specific variations noted for different surgical scenarios.
Abstract:
In our study, 60 infants and children, each with a severe subglottic stenosis (SGS), underwent partial cricotracheal resection (PCTR) with primary thyrotracheal anastomosis. According to the Myer-Cotton classification, two were grade II, 41 were grade III and 17 were grade IV stenoses. Of the 60 patients, 57 (95%) are presently decannulated, and one patient sustained a complete restenosis. Two patients with better than 80% subglottic airways still are waiting for decannulation: one because of bilateral cricoarytenoid joint fixation and the second because of temporary stenting of the subglottis with a Montgomery T-tube. The rate of decannulation is 97% (36 of 37 cases) in primary PCTRs, 100% (13 of 13 cases) in salvage PCTRs for failed laryngotracheal reconstructions (LTR) and 70% (7 of 10 cases) in extended PCTRs (i.e., PCTR associated with an additional open-airway procedure).