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Management of tracheal stenosis in children
1Dept. of Otolaryngology, Head and Neck Surgery, Maryland Hospital for Children, University of Maryland School of Medicine, Baltimore, USA.
Insights
Pediatric tracheal surgery for complete tracheal rings has a high mortality rate, but outcomes improve with recent surgical techniques. Tracheal resection and anastomosis offer better decannulation rates for tracheal stenosis.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Congenital Malformations
Background:
- Complete tracheal rings are rare congenital anomalies.
- Tracheal stenosis can result from various causes, requiring surgical intervention.
Purpose of the Study:
- To review the presentation and outcomes of pediatric patients with complete tracheal ring malformation.
- To evaluate outcomes of tracheal resection or partial cricoid resection with primary tracheal anastomosis for tracheal stenosis.
Main Methods:
- Retrospective chart analysis conducted at a US academic tertiary referral pediatric hospital.
- Study included 23 children with complete tracheal rings (1985-1995) and 16 with tracheal stenosis (1984-1995).
Main Results:
- Mortality for complete tracheal rings was 39%, with recent improvements to 25%.
- Tracheal resection with primary anastomosis showed a 92% decannulation rate.
- Partial cricoid resection with primary thyrotracheal anastomosis achieved 100% decannulation.
Conclusions:
- Surgical repair of complete tracheal rings in children remains challenging with significant mortality.
- Tracheal resection and primary anastomosis, as well as partial cricoid resection, demonstrate favorable outcomes for tracheal stenosis.
Objective:
Review presentation and outcome in pediatric patients identified either because of complete tracheal ring malformation or those undergoing tracheal resection or partial cricoid resection with primary tracheal anastomosis.
Design:
Retrospective chart analysis in an academic tertiary referral pediatric hospital in the United States.
Participants:
Twenty-three children undergoing surgical repair of complete tracheal ring malformation from 1985 to 1995. Sixteen children with tracheal stenosis undergoing resection from 1984 to 1995.
Results:
In patients with complete tracheal rings the mortality rate is 39% (9/23) with 47% (11/23) now extubated. The recent mortality rate is 25% (2/8) with 62% (5/8) now extubated. Sixteen patients underwent tracheal resection or cricotracheal resection. Twelve patients had tracheal resection with primary tracheal anastomosis. Eleven of these are now decannulated (92%). Four patients underwent partial cricoid resection with primary thyrotracheal anastomosis. All of these patients are decannulated without need for further surgery (100%).