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Airway and Swallowing Outcomes Following Laryngotracheoplasty With Posterior Grafting in Children
Yann-Fuu Kou1, Andrew Redmann2, Meredith E Tabangin3
1Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
Insights
Laryngotracheoplasty with posterior grafting (LTP PCCG) effectively treats posterior glottic stenosis and bilateral vocal cord immobility in children, leading to high decannulation rates and improved oral feeding. While temporary swallowing issues may occur, most patients achieve oral feeding post-surgery.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Airway Surgery
- Swallowing Disorders in Children
Background:
- Posterior glottic stenosis (PGS) and bilateral vocal cord immobility (BVCI) are common pediatric airway issues.
- Laryngotracheoplasty with posterior grafting (LTP PCCG) is a surgical option for these conditions.
- Evaluating functional outcomes, including swallowing and airway patency, is crucial.
Purpose of the Study:
- To assess swallowing and airway outcomes in pediatric patients following LTP PCCG.
- To determine the efficacy of LTP PCCG in managing PGS and BVCI.
- To analyze decannulation rates and the need for feeding support.
Main Methods:
- Retrospective review of 31 pediatric patients undergoing LTP PCCG (2016-2019).
- Inclusion of demographics, indications, surgical approach, and revision status.
- Evaluation of pre- and post-operative swallowing assessments and airway outcomes.
Main Results:
- The primary indications were PGS (64.5%) and BVCI (35.5%).
- Post-surgery, 80.6% of patients were primarily orally fed, with no new gastrostomy tube placements.
- Decannulation success was high (96.8%), with an average decannulation time of 3.7 months.
Conclusions:
- LTP PCCG is effective for treating PGS and BVCI, achieving high decannulation rates.
- The procedure may temporarily impact swallowing, but most children achieve oral feeding.
- LTP PCCG demonstrates significant success in improving airway patency and functional outcomes.
Objectives/Hypothesis:
Evaluate swallowing and airway outcomes following laryngotracheoplasty with posterior grafting (LTP PCCG).
Methods:
Retrospective review of pediatric patients undergoing LTP PCCG from 2016 to 2019 at a tertiary care pediatric hospital. We included demographics, indications, approach, and revision status. We evaluated preoperative and postoperative instrumental and functional swallow evaluations, and we also gathered information on airway outcomes.
Results:
Thirty-one patients were included in the study. Median (interquartile range [IQR]) age was 4.0 (2.0, 7.0) years old. Primary indication for surgery was bilateral vocal cord immobility (BVCI) in 11 (35.5%) and posterior glottic stenosis (PGS) in 20 (64.5%). Mean (standard deviation) length of follow-up was 11.0 (8.3) months. Twelve patients had gastrostomy tubes (GT) before surgery, and no patients required placement of GT after surgery. Of the remaining 19 patients, 6 required nasogastric feeding for >4 weeks (average length 1.8 months, longest 3.5 months). At last follow-up, 25 (80.6%) patients were primarily orally fed. Eighteen patients had tracheotomies prior to surgery. No patients without a tracheostomy required placement of tracheostomy before or after surgery and only 1 patient had a tracheostomy at last follow-up. Average time to decannulation was 3.7 months, with surgery-specific success of 87.1% and overall success of 96.8%. Four (12.9%) patients required a major intervention to achieve decannulation.
Conclusion:
LTP PCCG is an effective surgical technique to address PGS and BVCI with high decannulation rates. It may cause temporary swallowing dysfunction, but in this series a majority of children were orally fed at last follow-up.
Level Of Evidence:
4 Laryngoscope, 131:2798-2804, 2021.
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