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The anterior cricoid split: the Children's Hospital of Philadelphia experience
G J Anderson1, L W Tom, R F Wetmore
1Division of Otolaryngology and Human Communication, Children's Hospital of Philadelphia, PA 19104.
Insights
The anterior cricoid split (ACS) procedure offers a viable alternative to tracheotomy for infants with subglottic stenosis. Success in this pediatric airway surgery correlates with shorter intubation times, achieving extubation in 73% of cases.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Surgery
- Pediatric Airway Management
Background:
- Subglottic stenosis presents a significant challenge in pediatric airway management.
- Tracheotomy is a common intervention, but carries potential complications.
- The anterior cricoid split (ACS) procedure emerged as an alternative surgical approach.
Observation:
- Twenty-six infants with subglottic stenosis underwent the ACS procedure between 1983 and 1987.
- Six of these patients had prior tracheotomy.
- The study evaluated the efficacy and outcomes of ACS in this pediatric cohort.
Findings:
- A successful outcome, defined by successful extubation or decannulation, was achieved in 73% of patients.
- Success was significantly correlated with decreased pre-operative intubation duration.
- Failure of the ACS procedure did not negatively impact subsequent management strategies.
Implications:
- The anterior cricoid split is a potentially effective intervention for pediatric subglottic stenosis.
- Shorter pre-operative intubation times may predict successful outcomes.
- ACS failure does not preclude other treatment options, offering a safety net for complex cases.
Abstract:
The anterior cricoid split procedure (ACS) is an alternative to tracheotomy in selected infants with subglottic stenosis. From February 1983 to October 1987, 26 children underwent ACS at the Children's Hospital of Philadelphia. All children had subglottic stenosis. Six children had previously undergone tracheotomy. A successful outcome, allowing extubation or decannulation, correlated only with decreased pre-operative intubation time and was achieved in 73% of these patients. A failed ACS had little adverse affect on the subsequent management of these children.