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Laryngotracheal reconstruction in children. Five-year follow-up
Insights
Subglottic stenosis in children can be challenging to manage. Laryngotracheal reconstruction offers a viable solution for severe cases, preserving laryngeal growth potential.
Area of Science:
- Pediatric Otolaryngology
- Laryngology
- Pediatric Surgery
Background:
- Subglottic stenosis is a frequent pediatric issue, often resulting from endotracheal intubation.
- Management of mature subglottic stenosis is controversial, with tracheotomy being a common but not always successful approach.
- Severe acquired lesions may not allow for spontaneous laryngeal growth and decannulation.
Purpose of the Study:
- To present a unique experience with laryngotracheal reconstruction in 103 children.
- To define indications for three widely used reconstructive procedures.
- To address concerns regarding the impact of reconstructive surgery on laryngeal growth.
Main Methods:
- Review of 103 pediatric cases undergoing laryngotracheal reconstruction.
- Analysis of indications for specific surgical techniques.
- Long-term follow-up of 35 patients to assess laryngeal growth.
Main Results:
- Laryngotracheal reconstruction was performed in 103 children with subglottic stenosis.
- Indications for three primary reconstructive procedures were established.
- No adverse effects on laryngeal growth were observed in 35 patients followed for at least five years.
Conclusions:
- Laryngotracheal reconstruction is an effective treatment for severe pediatric subglottic stenosis.
- Established indications guide the selection of appropriate surgical techniques.
- Reconstructive surgery does not appear to impede laryngeal growth in pediatric patients.
Abstract:
Congenital and acquired subglottic stenosis is a commonly encountered problem in the pediatric population. In acquired cases endotracheal intubation is responsible for its development in the great majority of cases, but high tracheotomy, laryngeal burns, external neck trauma, and tumors, both intrinsic and extrinsic, are occasionally seen. The management of mature subglottic stenosis in children remains a controversial issue. The prevailing attitude of otolaryngologists is to perform a tracheotomy and hope for decannulation after one or two years, due to the expected growth of the larynx. Unfortunately, some of the acquired lesions are so severe that often no lumen is demonstrable. In such cases no amount of growth will allow extubation. A variety of endoscopic methods, such as dilation with or without resection using diathermy or laser, are certainly helpful in the early phases of wound healing while the scar tissue is soft and pliable. To deal with the mature, hard, fibrous, unresponsive scar various authors have proposed differing laryngotracheal reconstructive techniques. The authors discuss a unique experience of laryngotracheal reconstruction in 103 children. They define their indications for the three procedures that are most widely used, and address the issue raised by opponents of laryngotracheal reconstruction in children, namely the consideration that laryngeal growth potential may be adversely affected by such external operations. The authors have evidence that this has not occurred in 35 cases followed for a minimum of five years.