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Endoscopic posterior cricoid split and costal cartilage graft placement in children
Mark E Gerber1, Vikash K Modi, Robert F Ward
1Division of Otolaryngology-Head and Neck Surgery, Northshore University HealthSystem, The University of Chicago Pritzker School of Medicine, Chicago, Illinois 60062, USA. mgerber@northshore.org
Insights
Endoscopic posterior cricoid split with costal cartilage graft (EPCSCG) effectively manages pediatric airway stenosis and vocal fold immobility. This technique offers a high success rate for decannulation and symptom control in children.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Airway Reconstruction
Background:
- Pediatric airway compromise due to bilateral vocal fold immobility (BVFI), posterior glottic stenosis (PGS), and subglottic stenosis (SGS) presents significant management challenges.
- Endoscopic surgical techniques are increasingly explored for minimally invasive treatment of these conditions.
Purpose of the Study:
- To evaluate the multi-institutional outcomes of endoscopic posterior cricoid split and costal cartilage graft (EPCSCG) placement.
- To assess the efficacy of EPCSCG in managing pediatric BVFI, PGS, and SGS.
Main Methods:
- A retrospective case series involving chart review of patients who underwent EPCSCG placement.
- Data collected from three tertiary medical centers between 2004 and 2012.
- Key outcomes included indications for surgery, complications, need for additional procedures, and decannulation rates.
Main Results:
- Twenty-eight pediatric patients underwent EPCSCG, with ages ranging from 1 month to 15 years.
- High success rates were observed: 25/28 patients were decannulated or never required tracheostomy, and 24/28 achieved adequate symptom control.
- Twenty-two patients experienced symptom resolution without further interventions; success rates for specific conditions like SGS and BVFI were also encouraging.
Conclusions:
- EPCSCG demonstrates consistent and favorable outcomes in a significant number of pediatric cases, exceeding previously reported series.
- This endoscopic approach is a valuable management option for pediatric glottic/subglottic stenosis and BVFI.
- The findings support EPCSCG as an important surgical choice for complex pediatric airway issues.
Objectives:
To review a multi-institutional experience using endoscopic posterior cricoid split and costal cartilage graft (EPCSCG) placement in the management of pediatric bilateral vocal fold immobility (BVFI), posterior glottic stenosis (PGS), and subglottic stenosis (SGS).
Design:
Case series with chart review.
Setting:
Tertiary medical centers.
Methods:
Review of all patients treated between 2004 and 2012 with EPCSCG placement in 3 academic and multispecialty group settings. The main outcomes measured include indications, complications, and outcome (need for additional procedures, decannulation rate).
Results:
A total of 28 patients underwent EPCSCG. Age range at time of surgery was 1 month to 15 years (mean, 56 months). Overall, 25 of 28 were decannulated or never required tracheostomy, and 24 of 28 had adequate symptom control with mean follow-up of 25 months. Twenty-two patients had resolution of their symptoms without additional procedures. Sixteen patients had SGS in isolation or in combination with cricoarytenoid fixation, glottic stenosis, or vocal fold immobility. Decannulation and/or symptom control was achieved in 14 of 16. Three patients had isolated PGS or cricoarytenoid fixation with all achieving decannulation. Nine patients had isolated BVFI with 7 being able to achieve resolution of their airway symptoms, 5 without additional procedures.
Conclusion:
This descriptive series shows a consistent outcome in more than double the number of cases previously reported in the previously published series. We believe that EPCSCG is an important option to have in the management of pediatric glottis/subglottic stenosis and bilateral vocal fold immobility.
