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Surgical options in suprastomal collapse-induced severe airway obstruction
Serap Sahin Onder1, A Ishii2, K Sandu3
1University of Health Science Umraniye Education and Research Hospital, Istanbul, Turkey.
Insights
This study evaluated surgical treatments for severe suprastomal collapse (SSC) in children. Various surgical options effectively resolved SSC, enabling successful decannulation and symptom relief in most patients.
Area of Science:
- Pediatric surgery
- Otolaryngology
- Respiratory medicine
Background:
- Severe suprastomal collapse (SSC) is a complex airway obstruction in tracheostomized children.
- Management of SSC requires tailored surgical approaches based on individual patient anatomy and pathology.
Purpose of the Study:
- To review a single institution's experience with diverse surgical interventions for severe suprastomal collapse (SSC).
- To assess the efficacy and outcomes of different surgical techniques in managing pediatric SSC.
Main Methods:
- Retrospective analysis of 18 tracheostomized children with SSC treated between 2012 and 2018.
- Data collected included patient demographics, airway lesions, comorbidities, tracheostomy details, stomal characteristics, surgical procedures, and outcomes.
Main Results:
- Four surgical techniques were employed: excision, rib cartilage augmentation, tracheal resection and anastomosis, and stomal rigidification.
- Complete resolution of SSC was achieved in 16 out of 18 patients, with successful decannulation and asymptomatic status.
- Minor postoperative complications like granulation tissue occurred in three patients, managed conservatively.
Conclusions:
- The choice of surgical technique for SSC should be individualized based on stoma and airway anatomy.
- Effective surgical management of SSC is crucial for successful decannulation and improved patient outcomes.
Purpose:
A single institutions experience with various surgical options in the treatment of severe suprastomal collapse (SSC).
Methods:
The study included 18 tracheostomized children with SSC treated between January 2012 and December 2018. Data included: patient demography, initial airway lesions, comorbidities, indication and age at tracheostomy, prior airway surgery, stomal demography, type of surgery, postoperative management, complications and treatment outcomes.
Results:
Four techniques were used to correct SSC. The surgical choice was dependent on stoma demography and associated airway lesions. Excision was done in eight patients and rib cartilage augmentation in five. Three patients had single stage tracheal resection and anastomosis. Two patients received stomal rigidification and temporary placement of Montgomery T tube. Three patients with anterior rib graft augmentation required additional lateral tracheal wall rigidification. Three patients (two with cartilage augmentation, and one with stomal rigidification) developed minimal granulation tissue in the postoperative period. Complete SSC resolution was seen in all except two patients who had a partial response to the treatment. All patients were successful decannulated and are currently asymptomatic.
Conclusion:
Decannulation failures may be due to severe suprastomal collapse that could be either unique or associated with obstructing laryngotracheal lesions. Therefore, it is essential to select the most appropriate surgical treatment to obtain overall favorable outcomes.
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