Prevention and management of laryngeal stenosis in infants and children

Acquired laryngeal stenosis is a well-documented complication of endotracheal intubation. Premature infants requiring ventilatory support for respiratory distress syndrome are at increased risk for developing laryngeal stenosis. Until recently, the techniques for repair of laryngeal stenosis have required a temporary tracheotomy which complicates the management and has an associated mortality. In 1980 the use of an anterior cricoid split was described to treat laryngeal stenosis in infants. The technique has been modified: the anterior cricoid split procedure as originally described required a single midline vertical incision through the anterior cartilaginous ring of the cricoid cartilage and the upper 2 tracheal rings; the modification is an extension of the superior limit of the incision in the thyroid cartilage to within 2 mm of the thyroid notch. The technique has been used in 45 children whose ages range from 4 days to 28 months. In addition to being of value for the treatment of laryngeal stenosis in premature infants (29 patients), 2 other clinical groups of children who benefit from the produce have been identified; 11 infants who developed laryngeal stenosis in the first 2 years of life secondary to intubation and in whom the anterior cricoid split was used as an alternative to tracheotomy; 5 infants under 2 years of age, each with a tracheotomy for laryngeal stenosis in whom the anterior cricoid split was used as an alternative to more extensive methods of laryngotracheal reconstruction. Of the premature infants (29), 18 were successfully extubated, 5 still required a tracheotomy, and 6 died before extubation was accomplished; the predominant cause of death was respiratory failure secondary to the underlying bronchopulmonary dysplasia.(ABSTRACT TRUNCATED AT 250 WORDS)