Modifications of airway reconstruction in children

We review our treatment experience of subglottic stenosis in 66 children. Sixty-one of these children required some form of airway expansion using cartilage grafts. Eight children had grade I (Cotton classification), 15 grade II, 28 grade III, and 15 grade IV stenosis. All patients with grade I and II lesions were decannulated. Ninety-three percent of grade III patients and 67% of grade IV patients were also ultimately decannulated. Laryngotracheal reconstruction with costal cartilage grafting has become widely accepted for treatment of severe laryngotracheal stenosis. Several modifications of this technique have been employed to treat our patients. Recently, we have used a modified single-stage technique with an endotracheal tube stent, externally secured for 1 week, to avoid postoperative intensive care unit admission for sedation and/or paralysis, and its related complications. Posterior graft design and placement without sutures was also performed in 20 cases. A two-surgeon technique that involves a simultaneous endoscopic control of incision of the stenotic area was employed. These modifications will be described in detail.