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Surgical correction of laryngotracheal stenoses in children
Insights
This study presents a modified Rhéti technique for laryngotracheal reconstruction in children, achieving over 80% success in improving respiration while noting mild voice hoarseness. The procedure effectively treats laryngotracheal stenosis without hindering laryngeal growth.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Thoracic Surgery
Background:
- Laryngotracheal stenosis in children poses significant respiratory challenges.
- Previous concerns existed regarding the impact of laryngoplasty on laryngeal growth.
Purpose of the Study:
- To describe and evaluate a modified Rhéti surgical technique for laryngotracheal stenosis.
- To assess the long-term efficacy and safety of this procedure in pediatric patients.
Main Methods:
- A modified Rhéti technique involving longitudinal dissection of cricoid and tracheal rings.
- Stabilization of lumen enlargement using costal cartilage interposition.
- Surgical intervention in 63 children with laryngotracheal stenosis since 1973.
Main Results:
- Successful laryngotracheal reconstruction in over 80% of pediatric patients.
- Adequate respiration achieved, with some patients decannulated for over 10 years.
- No impairment of laryngeal growth observed, disproving earlier concerns.
Conclusions:
- The modified Rhéti technique is a successful surgical option for pediatric laryngotracheal stenosis.
- The procedure provides adequate respiration with acceptable voice outcomes.
- Prognosis is negatively impacted by associated anomalies like vocal cord paralysis.
Abstract:
A modified surgical technique according to Rhéti is described: the cricoid and the uppermost tracheal rings are longitudinally dissected ventrally and dorsally. The enlargement of the lumen is stabilized by interposition of a notched piece of costal cartilage into the dissected posterior wall of the cricoid. A total of 63 children with laryngotracheal stenosis have been operated on by this method in Zurich since 1973 and in Munich since 1982. Laryngotracheal plasty is successful in over 80% of small children in whom the procedure is necessary. The voice becomes a little hoarse, but respiration is adequate, as demonstrated by our juvenile patients, some of whom have been decannulated for over 10 years. The earlier opinion that laryngoplasty performed in small children might impair laryngeal growth and result in severe stenoses has been disproved by the results presented. Our experience shows that prognosis is worse in children with tracheal stenosis and associated anomalies, such as paralysis of the vocal cord.