Partial cricoid resection with primary tracheal anastomosis for subglottic stenosis in infants and children

Area of Science:

• Pediatric Otolaryngology
• Laryngology
• Pediatric Surgery

Background:

• Severe subglottic stenosis poses significant challenges in infants and children, often requiring prolonged tracheotomy dependence.
• Congenital and acquired (post-intubation) etiologies are common, with many patients presenting with high-grade obstruction (Cotton grades III-IV).

Purpose of the Study:

• To evaluate the efficacy and outcomes of partial cricoid resection with primary tracheal anastomosis in pediatric patients with severe subglottic stenosis.

Main Methods:

• Fifteen infants and children with severe subglottic stenosis underwent partial cricoid resection, with or without a tracheal segment (1-4 rings).
• Surgical procedures involved primary tracheal anastomosis, aiming for decannulation.
• Patients were assessed for decannulation rates, recurrent laryngeal nerve function, voice quality, respiratory status, and long-term laryngotracheal development.

Main Results:

• Successful decannulation was achieved in 14 out of 15 (93%) patients after a single procedure.
• Twelve patients were decannulated within 6 months, with 10 showing normal postoperative voice and 12 experiencing no exertional dyspnea.
• No recurrent laryngeal nerve injuries or fatalities occurred; one case of restenosis was noted. Long-term follow-up (up to 14 years) showed normal laryngotracheal development.

Conclusions:

• Partial cricoid resection with primary tracheal anastomosis is a highly effective surgical option for severe subglottic stenosis in children, yielding excellent decannulation rates and functional outcomes.
• The procedure demonstrates favorable results compared to laryngotracheoplasty and should be considered a primary treatment option for this challenging condition.