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Published on: April 1, 2019
Thyroid alar cartilage graft in paediatric laryngotracheal reconstruction
1Department of Otolaryngology, Head and Neck Surgery, Claude Huriez Hospital, University Hospital of Lille, 2 Avenue Oscar Lambret, CHRU Lille, 59037 Lille Cedex, France. fayoux.pierre@voila.fr
Insights
Thyroid alar cartilage (TAC) grafts are feasible for pediatric laryngotracheal reconstruction, particularly for moderate subglottic stenosis. This approach reduces operative time and cosmetic issues with outcomes comparable to other grafts.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Regenerative Medicine
Background:
- Laryngotracheal stenosis in children presents significant challenges.
- Current reconstructive techniques have limitations.
- Thyroid alar cartilage (TAC) offers a potential autologous graft material.
Purpose of the Study:
- To evaluate the indications and outcomes of TAC grafts in pediatric laryngotracheal reconstruction (LTR).
- To assess the feasibility and safety of TAC grafting in infants.
Main Methods:
- A case series of 27 infants undergoing TAC grafting for subglottic stenosis or post-tumor resection laryngeal enlargement.
- Prospective endoscopic follow-up to evaluate graft healing and airway patency.
Main Results:
- Successful extubation in 92.5% of patients within 5.1 days.
- No major perioperative or postoperative complications.
- Graft epithelialization averaged 18.1 days; granulation tissue occurred in 32% but resolved.
- No laryngeal asymmetry or feeding issues observed.
Conclusions:
- Thyroid alar cartilage grafting is a feasible option for pediatric LTR, especially for moderate subglottic stenosis.
- TAC grafting can reduce operative time and cosmetic deformities.
- Graft healing is comparable to other cartilage grafts, with no induced laryngeal deformation noted in this series.
Objective:
To evaluate the potential indications of thyroid alar cartilage (TAC) graft in the paediatric laryngotracheal reconstruction (LTR) population based on observations obtained in a case series of 27 consecutive infants referred to our tertiary care center.
Methods:
Thyroid alar cartilage grafting was performed for limited Myer grade II and grade III subglottic stenosis requiring a single-stage laryngoplasty and for laryngeal enlargement after translaryngotracheal resection of endolaryngeal tumors. The evolution of the grafted area was evaluated prospectively during endoscopic follow-up.
Results:
Twenty-five patients (92.5%) were successfully extubated after a mean of 5.1 days. No perioperative or postoperative complications were observed. The mean duration of graft harvesting was 7.7 min. Follow-up of the grafted area revealed one case of partial necrosis without prolapse into the lumen. The mean duration of graft epithelialization was 18.1 days (range: 12-30 days). Development of granulation tissue was observed in eight patients (32%) with a mean duration of granulation tissue persistence of 61.5 days (range: 7-155 days). Endoscopic follow-up did not demonstrate any pharyngolaryngeal asymmetry or feeding difficulties.
Conclusion:
This study demonstrated that the use of thyroid alar cartilage grafting is feasible for pediatric laryngotracheal reconstruction. The indications of thyroid alar cartilage graft should be reserved for moderated subglottic stenosis. The use of TAC reduced the operative time and cosmetic sequelae significantly. The healing of the grafted area was similar to those obtained with other types of graft. The TAC removal did not induce laryngeal deformation but longer follow-up is necessary to confirm this.
