[Surgical treatment of laryngotracheal stenosis in childhood]
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J Uroz-Tristán1, L Sanchís Solera, J Benítez del Rosario
1Servicio de Cirugía Pediátrica, Hospital Materno Infantil, Las Palmas de Gran Canaria.
Insights
Anterior cricoid split with prolonged intubation effectively treats pediatric laryngotracheal stenosis. This safe technique offers a useful alternative for infants at risk, improving upper airway obstruction outcomes.
Area of Science:
- Pediatric surgery
- Otolaryngology
- Respiratory medicine
Background:
- Laryngotracheal stenosis is uncommon in children but poses significant risks for premature infants requiring prolonged mechanical ventilation.
- Previous treatments for this condition have been associated with high morbidity and mortality rates.
Purpose of the Study:
- To evaluate the safety and efficacy of the anterior cricoid split procedure as a primary treatment for pediatric laryngotracheal stenosis.
- To assess outcomes in infants undergoing this surgical intervention.
Main Methods:
- The anterior cricoid split technique was applied to the upper two tracheal rings in five pediatric patients (ages 4-18 months) between 1991 and an unspecified date.
- Patients were managed with either a standard endotracheal tube or a Montgomery tube, with extubation occurring between 5 and 340 days post-surgery.
Main Results:
- Four patients experienced extubation failure due to varying degrees of stenosis, while one had respiratory distress secondary to subcricoid stenosis.
- Two patients had complications: a skin-tracheal fistula and left vocal cord paresis, both resolving without long-term issues.
- All patients were discharged without upper airway obstruction, except for one with a granuloma that responded to cortisone treatment.
Conclusions:
- Anterior cricoid split combined with prolonged intubation is a safe and effective treatment for pediatric laryngotracheal stenosis.
- This technique demonstrates utility in managing infants with this challenging condition, leading to successful outcomes.
Abstract:
Acquired or congenital laryngotracheal stenosis is uncommon in children although premature infants with respiratory distress syndrome (SDR) requiring ventilatory support with prolonged intubation are at great risk. The different treatments used in the past show high rates of morbidity and mortality. Following the technique described by Cotton in 1980, anterior cricoid slit procedure in the upper two tracheal rings has been used as a primary treatment on five patients since 1991, four by intrinsic stenosis and one by extrinsic. Extubation failed in four of them, checking trough bronchoscopy different grades of laryngotracheal stenosis and in the fifth due to respiratory distress, secondary to subcricoid stenosis. Anterior cricoid split procedure with intubation with conventional endotracheal tube (SET) or Montgomery tube (TTM) was performed on infants whose ages ranged from 4 to 18 months old (averaged 8 months). They were extubated between the 5th and 340th days after surgery. Two of them underwent complications: a skin-tracheal fistula and a paresis of the left vocal cord, the two are asymptomatic after four and eighteen months of the procedure. All patients discharged without signs of upper airway obstruction, except one who developed a granuloma which diminished with cortisone. Anterior cricoid split with prolonged intubation is a safe and useful technique for the treatment of laryngotracheal stenosis.