Acquired tracheal stenosis in infants and children

Acquired tracheal stenosis in childhood is frequently difficult to manage because of poor healing, infection, and scarring. In a 10-year period, 62 patients (4 weeks to 14 years of age) were treated for acquired tracheal stenosis. The causes of stenosis were endotracheal intubation (44 patients), caustic aspiration (6 patients), recurrent infection (5 patients), bronchoscopic perforation (4 patients), and gastric aspiration (3 patients). The subglottic or upper trachea was involved in 47 patients, mid portion in 8, and distal or carinal area in 7. Fifty children underwent tracheostomy as part of the therapy, and 12 were managed without tracheostomy. Therapy was individualized, frequently sequentially, utilizing rigid or balloon dilatation (20 patients), bronchoscopic electrocoagulation resection (44 patients), steroid injection (48 patients), T tube stent (8 patients), resection with anastomosis (12 patients), cricoid split (3 patients), and rib cartilage graft (12 patients). Most patients required several techniques and repeated procedures to eventually achieve decannulation. Seven patients (11%) died of unrelated causes. Forty-four of 55 surviving patients (80%) are without tracheostomy, although 14 have required continued endotracheal treatment after tracheostomy removal (dilatation, endotracheal resection). This series demonstrates that acquired tracheal stenosis in childhood is a common, difficult problem, but manageable with the use of a variety of techniques. Resection and grafting procedures should be reserved for cases in which less complex modalities fail.