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Experience with anterior cricoid split for infantile subglottic stenosis
1Department of Otolaryngology, Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Anterior cricoid split (ACS) surgery is a safe and effective treatment for infantile subglottic stenosis (SGS). This study shows a high success rate for ACS in managing SGS, offering an alternative to tracheostomy.
Area of Science:
- Pediatric surgery
- Otolaryngology
- Respiratory medicine
Background:
- Infantile subglottic stenosis (SGS) presents significant management challenges.
- Tracheostomy is a common intervention, but carries risks.
- Anterior cricoid split (ACS) offers a potential alternative surgical approach.
Purpose of the Study:
- To evaluate the safety and efficacy of anterior cricoid split (ACS) in managing infantile subglottic stenosis (SGS).
- To assess the rate of successful extubation and need for further interventions after ACS.
Main Methods:
- Retrospective study of 12 infants undergoing ACS between 1989 and 1993.
- Patients included those dependent on endotracheal tubes, CPAP, or with recurrent croup.
- Analysis of surgical outcomes, including extubation success and subsequent procedures.
Main Results:
- Eleven of 12 infants were successfully extubated post-ACS.
- Two patients required repeat ACS, and one eventually needed a tracheostomy.
- ACS demonstrated a high rate of successful extubation for various SGS presentations.
Conclusions:
- Anterior cricoid split (ACS) is a viable and safe alternative to tracheostomy for infantile subglottic stenosis (SGS).
- The procedure facilitates successful extubation in a majority of cases.
- ACS management of SGS shows promising outcomes in this retrospective series.
Abstract:
A retrospective study of infants undergoing anterior cricoid split (ACS) from 1989 to 1993 was performed to evaluate our unit's experience with ACS in the management of infantile subglottic stenosis (SGS). Twelve children were identified ranging in age from 10 to 30 weeks and weighing between 1200 and 6500 g. Nine were born at or less than 30 weeks' gestation. Indications for surgery were endotracheal tube dependency, nasopharyngeal continuous positive airway pressure dependency and recurrent croup. All had varying degrees of SGS. Eleven of the 12 patients were extubated successfully following surgery. Two of these required subsequent repeat ACS 6 and 9 months later with one patient eventually requiring tracheostomy. These results suggest that ACS can be safely employed as an alternative to tracheostomy for a variety of clinical presentations of infantile SGS, with a relatively high rate of successful extubation.