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[Tracheal stenosis in children and its operative management (author's transl)]
Insights
This study presents a surgical technique for treating subglottic tracheal stenosis in children, often caused by intubation or tracheostomy. The method reconstructs the airway using grafts and flaps, successfully restoring breathing in pediatric and adult patients.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Thoracic Surgery
Background:
- Tracheal stenosis, particularly subglottic disease, poses a significant challenge in pediatric airway management.
- Common etiologies include prolonged intubation and emergency tracheostomies secondary to trauma.
Observation:
- A surgical technique involving vertical division and lateral stretching of the trachea and cricoid cartilage is detailed.
- Debridement of granulation tissue, scar, and cartilage dislocation is performed.
- Reconstruction utilizes free mucosal grafts or pedicle skin flaps to cover the denuded area.
Findings:
- An acrylic prosthesis is used to maintain airway patency for several weeks post-surgery.
- The tracheal defect is closed with a composite graft from the auricle.
- A temporary tracheostomy is maintained for 2-3 weeks, with neck defect closure via a transposition flap.
Implications:
- This reconstructive approach has demonstrated success in pediatric patients (ages 3, 5, and 7) since 1971.
- The technique is also effective in adult patients, with successful outcomes in five adult cases.
- The described method offers a viable solution for complex tracheal stenosis, improving patient outcomes and airway function.
Abstract:
The problem of tracheal stenosis in children is discussed, with emphasis placed on subglottic disease. The primary etiologies for the stenosis were chronic intubation and emergency tracheostomies following accidents. The operative technique described utilizes vertical division of the trachea and cricoid in the midline. The margins are then stretched laterally and sutured to skin incision lines. Granulations, scar and dislocated cartilage are removed, and the denuded area covered with free mucosal grafts or with pedicle skin flaps. After reestablishing an adequate airway (with use of an acrylic prosthesis for several weeks), the tracheal groove is closed with a composite graft from the auricle. A tracheostomy is left in place an additional 2-3 weeks, while the raw neck area is resurfaced by a transposition flap from adjacent skin. The technique has worked well since 1971 in three children (aged 3, 5 and 7 years), and was also performed successfully on five adult patients.