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Updated: Sep 12, 2025
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Published on: August 2, 2024
Predicting graft width in endoscopic cricoid split using endotracheal tube outer diameter: a pediatric case series
Zahra Almoumen1,2, Abdulrahman Almutairi3, Luluh Alsughayer3
1Department of Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia. Zahra.h.almoumen@gmail.com.
Insights
Endotracheal tube outer diameter (ETT OD) reliably predicts graft width in endoscopic posterior cricoid split with rib graft (EPCS/RG). A predictive model using ETT OD can guide graft sizing in pediatric airway reconstruction.
Area of Science:
- Pediatric Otolaryngology
- Airway Surgery
- Surgical Reconstruction
Background:
- Pediatric airway stenosis often requires surgical intervention.
- Endoscopic Posterior Cricoid Split with Rib Graft (EPCS/RG) is a reconstructive technique.
- Accurate graft sizing is crucial for successful outcomes in EPCS/RG.
Purpose of the Study:
- To determine the correlation between endotracheal tube outer diameter (ETT OD) and graft width in EPCS/RG.
- To develop a predictive model for selecting appropriate graft size.
- To evaluate the impact of graft size on surgical outcomes.
Main Methods:
- Retrospective case series of 12 pediatric patients undergoing EPCS/RG.
- Analysis of correlation between ETT OD and graft width using linear regression and Pearson correlation.
- Assessment of secondary outcomes including tracheostomy status and operative time.
Main Results:
- A moderate-to-strong positive correlation (r=0.576, p=0.004) was found between ETT OD and graft width.
- A predictive equation was derived: Graft width = 0.6 + (0.9 × ETT OD).
- Tracheostomy avoidance or decannulation was achieved in 75% of patients.
Conclusions:
- Endotracheal tube outer diameter is a reliable predictor of graft width for EPCS/RG.
- The developed model offers a data-driven approach to graft sizing.
- Larger studies are needed to validate the predictive equation for pediatric airway reconstruction.
Objective:
To evaluate the correlation between endotracheal tube outer diameter (ETT OD) and graft width in Endoscopic Posterior Cricoid Split with Rib Graft (EPCS/RG) and propose a predictive model to guide graft size selection.
Design, Setting, And Participants:
A retrospective case series involving 12 pediatric patients who underwent EPCS/RG at a tertiary academic center between 2017 and 2024.
Main Outcomes And Measures:
Primary outcome was correlation between ETT OD and graft width. Secondary outcomes included tracheostomy status, postoperative respiratory symptoms, and operative time. Linear regression and Pearson correlation analyses were performed.
Results:
The mean patient age was 10.0 ± 4.9 years. The average ETT OD was 7.7 ± 1.67 mm, and the mean graft width was 7.5 ± 1.98 mm. A moderate-to-strong positive correlation was observed between ETT OD and graft width (r = 0.576, p = 0.004). The resulting regression equation was: Graft width = 0.6 + (0.9 × ETT OD). Tracheostomy was avoided in 58.3% of patients, while decannulation of pre-existing tracheostomies was achieved in 16.7% of patients. No significant correlation was found between graft width ratio and operative time (Pearson r = -0.24, p = 0.45).
Conclusions:
ETT OD is a reliable predictor of graft width in EPCS-RG. This data-driven model supports a structured approach to graft sizing, though limited by small number of cases. Further studies with larger sample size are recommended to validate the proposed equation.
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