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Endoscopic posterior cricoid split with costal cartilage graft placement in patients under one year of age
Jeffrey C Mecham1, Dana N Eitan2, Austin DeHart3
1Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
Insights
Endoscopic posterior cricoid split with costal rib graft (EPCSCG) successfully enlarged airways in infants. This procedure helped 7 of 8 young patients avoid tracheostomy for airway issues.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Respiratory Medicine
Background:
- Neonates and infants have small airways that can be disproportionately affected by conditions causing airway obstruction.
- Glottic and subglottic stenosis, often due to bilateral vocal fold immobility, present significant challenges in pediatric airway management.
Observation:
- A series of 8 infants under one year of age underwent endoscopic posterior cricoid split and costal rib graft placement (EPCSCG).
- Indications included isolated bilateral vocal fold immobility (6/8), bilateral vocal fold immobility with subglottic stenosis (1/8), and isolated subglottic stenosis (1/8).
Findings:
- EPCSCG was successfully performed in all 8 pediatric patients.
- A significant majority (7/8) avoided the need for tracheostomy following the procedure.
- The technique effectively enlarged the glottic and subglottic airway in this cohort.
Implications:
- EPCSCG is a viable and safe surgical option for select infants with glottic and subglottic airway compromise.
- This endoscopic approach offers a potential alternative to tracheostomy, improving outcomes for affected neonates and infants.
- Further research can explore long-term efficacy and expand indications for EPCSCG in pediatric airway reconstruction.
Abstract:
Endoscopic posterior cricoid split and costal rib graft placement (EPCSCG) is an important tool in enlarging the glottic and subglottic airway, both of which can be disproportionally affected in the small airways of neonates and early infants. We present a series of 8 patients under the age of one who successfully underwent EPCSCG, with 7/8 patients avoiding tracheostomy entirely. Of these patients, the indication for EPCSCG was isolated bilateral vocal fold immobility (6/8), bilateral vocal fold immobility with subglottic stenosis (1/8), and isolated subglottic stenosis (1/8). EPCSCG can be safely applied to select patients less than one year of age.
