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Surgical treatment for laryngotracheal stenosis in the pediatric patient
P Narcy1, P Contencin, I Fligny
1Robert Debré Children's Hospital, X. Bichat School of Medicine, Paris, France.
Insights
This study reviewed 115 pediatric patients with severe laryngotracheal stenosis (LTS). Surgical outcomes showed high decannulation success rates for both congenital and acquired LTS, though some required multiple procedures.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Respiratory Medicine
Background:
- Laryngotracheal stenosis (LTS) in children presents significant surgical challenges.
- The study focuses on severe cases, including congenital and acquired subglottic stenosis (SGS).
- Acquired SGS is frequently associated with prolonged endotracheal intubation.
Purpose of the Study:
- To review surgical outcomes for pediatric LTS over a 12-year period.
- To evaluate the effectiveness of various surgical techniques for LTS.
- To present current management trends for subglottic stenosis.
Main Methods:
- Retrospective review of 115 pediatric patients with LTS undergoing surgery.
- Classification of stenosis severity using Cotton's criteria.
- Analysis of surgical procedures including laryngotracheoplasty, cartilage grafting, and cricoid cuts.
Main Results:
- Successful decannulation was achieved in 44/45 cases of congenital SGS, with 7 needing repeat procedures.
- The decannulation rate for acquired SGS was 89% (62/70), with 14 patients requiring multiple surgeries.
- A significant proportion of patients, 46, weighed under 10 kg at the time of surgery.
Conclusions:
- Surgical intervention for pediatric LTS demonstrates high success rates for decannulation.
- Congenital SGS generally has a better prognosis than acquired SGS.
- Management strategies for pediatric subglottic stenosis continue to evolve.
Abstract:
We report our experience with laryngotracheal stenosis (LTS) in children during the last 12 years. Documentation and follow-up were available for 115 patients who underwent surgery for acquired or congenital LTS. Most were severe cases according to Cotton's classification. Forty-six weighed less than 10 kg at the time of surgery; 45 had pure congenital subglottic stenosis; 70 had acquired subglottic stenosis, mainly due to endotracheal intubation. The surgical techniques used have been various. The three main types of procedure were castellated laryngotracheoplasty, anterior cartilage rib grafting, and anterior and posterior cricoid cuts with or without grafting. All cases but 1 (44/45) of congenital subglottic stenosis have been successfully decannulated, 7 requiring a second procedure. The decannulation rate for acquired SGS was 89% (62/70), but 14 patients required multiple procedures. Current trends in subglottic stenosis management in our institution are presented.