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Anterior cricoid split for subglottic stenosis: experience at the Children's Hospital of New Jersey
S Palasti1, D S Respler, R J Fieldman
1Children's Hospital of New Jersey, Newark.
Insights
The anterior cricoid split (ACS) operation effectively treated subglottic stenosis (SGS) in 21 of 25 children. This pediatric surgery offers a valuable first-line approach for managing SGS with a high success rate.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Respiratory Medicine
Background:
- Subglottic stenosis (SGS) is a serious airway obstruction in children.
- Acquired and congenital causes necessitate effective surgical interventions.
- The anterior cricoid split (ACS) is a surgical technique for SGS.
Purpose of the Study:
- To evaluate the efficacy of the anterior cricoid split (ACS) operation.
- To assess the outcomes and complications of ACS in pediatric patients with SGS.
- To determine if ACS is a suitable first-line treatment for SGS.
Main Methods:
- Retrospective study of 25 pediatric patients with SGS.
- Patients underwent the anterior cricoid split (ACS) procedure.
- Data collected on patient age, diagnosis, surgical outcomes, and complications.
Main Results:
- 84% of patients (21/25) were successfully extubated after ACS.
- Patients remained stable with an average follow-up of 10 months.
- Common complication was atelectasis (48%); other complications were infrequent.
Conclusions:
- The anterior cricoid split (ACS) is a valuable and effective first-line procedure for pediatric subglottic stenosis.
- ACS demonstrates a high success rate in managing SGS in children.
- Further research may explore long-term outcomes and management of specific complications.
Abstract:
Twenty-five children with acquired and congenital subglottic stenosis (SGS) were managed with the anterior cricoid split (ACS) operation at the authors' institution from September 1987 to January 1990. Ages ranged from 2.5 months to 5.5 years. Twenty-one (84%) of the children were extubated after 5 to 14 days of nasotracheal intubation and have remained stable after an average follow-up of 10 months. Atelectasis was a common postoperative problem, encountered in 12 (48%) of the patients. Other complications included a tracheocutaneous fistula, prolapse of soft tissue into the tracheal lumen via the cricoid incision, a subglottic granuloma, and 2 cases of prolonged lower extremity paresis following reversal of vecuronium. The results of this retrospective study indicate that the ACS is a valuable first-line procedure for the management of SGS in a variety of pediatric patients.