Innovations in pediatric laryngotracheal reconstruction

Techniques for the reconstruction of pediatric subglottic and tracheal stenoses continue to undergo modification and refinement. The modified Réthi procedure of anterior laryngotracheal division and posterior cricoidotomy may be supplemented by unilateral or bilateral division of the cricoid cartilage for increased expansion of the subglottic lumen. The resulting four-quadrant division of the cricoid cartilage can be used in conjunction with the placement of cartilaginous grafts and stenting techniques common to laryngotracheal reconstruction (LTR). From October 1, 1986, to January 10, 1990, 31 four-quadrant division procedures were performed in 29 patients. Overall, decannulation has been achieved in 22 of 29 patients (76%). Another technique in LTR is the use of endotracheal tube stenting, resulting in single-stage LTR. The endotracheal tube supports the surgically expanded lumen for a period of intubation, followed by extubation. On extubation, the patient is effectively decannulated because the tracheostomy site is closed during the reconstructive procedure. From January 1, 1985, to July 31, 1990, 36 single-stage LTRs were performed in 35 patients. Overall successful results have been achieved in 30 of 35 (86%) of single-stage LTR patients.