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Partial cricotracheal resection in children: potential pitfalls and avoidance of complications

Mercy George1, Christos Ikonomidis, Yves Jaquet

  • 1Department of Otolaryngology, Head and Neck Surgery, University Hospital (CHUV), Lausanne, Vaud, Switzerland 1011. roymercy@hotmail.com

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|August 1, 2009
PubMed

Insights

Factors influencing pediatric decannulation after partial cricotracheal resection (PCTR) were studied. Addressing comorbidities and glottic involvement are key to successful outcomes and avoiding revision surgery.

Area of Science:

  • Pediatric Otolaryngology
  • Surgical Outcomes Research
  • Airway Reconstruction

Background:

  • Severe subglottic stenosis in children often requires surgical intervention like partial cricotracheal resection (PCTR).
  • Decannulation success after PCTR is crucial for restoring normal airway function.
  • Factors contributing to delayed or failed decannulation require thorough investigation.

Purpose of the Study:

  • To identify factors associated with failure or delay in decannulation following PCTR in pediatric patients.
  • To analyze the impact of stenosis grade and surgical complications on decannulation rates.

Main Methods:

  • Retrospective case review of 100 children undergoing PCTR between 1978 and 2008.
  • Analysis of preoperative stenosis grades (II-IV) and postoperative outcomes, including decannulation rates and revision surgeries.
  • Evaluation of complications such as anastomotic dehiscence and glottic stenosis.

Main Results:

  • A 90% overall decannulation rate was achieved.
  • Decannulation rates varied by stenosis grade: 100% for grade II, 95% for grade III, and 78% for grade IV.
  • Revision surgery was needed in 14% of patients, primarily for posterior glottic stenosis; 6% mortality occurred, unrelated to surgery.

Conclusions:

  • Preoperative management of comorbidities and associated syndromes is vital for optimal decannulation outcomes.
  • Careful intraoperative assessment for double-stage surgery in extensive resections (>5 rings) can mitigate anastomotic dehiscence.
  • Subglottic stenosis with glottic involvement presents a significant challenge, often requiring revision procedures.
Abstract

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