Abstract
Purpose
The present study analyzed the clinical features and surgical outcomes of laryngotracheal reconstruction (LTR) in pediatric patients with severe acquired subglottic stenosis (SGS) based on the range of stenosis. The aim was to clarify the indications for LTR in severe acquired SGS.
Methods
The medical records of 33 pediatric patients with severe acquired SGS (Myer-Cotton grade III or IV) at our institution between January 1994 and December 2013 were retrospectively reviewed.
Results
Nine patients had stenosis localized at the subglottis (localized SGS), and twenty-four patients had stenosis extending to the glottis or supraglottis from the subglottis (extended SGS). 66.7 % (6/9) of localized SGS patients were intubated after infancy, and 95.8 % (22/23) of extended SGS patients were intubated in the neonatal period. The duration of intubation was significantly shorter with localized than with extended SGS. Sixteen patients underwent LTR. The operation-specific decannulation rate was 80.0 % (4/5) in the localized SGS group and 14.3 % (1/7) in the extended SGS group.
Conclusion
The range of stenosis was affected by the period and duration of endotracheal intubation. Surgical outcomes of LTR tended to differ between localized SGS and extended SGS. LTR can be effective for localized SGS.
This is a preview of subscription content, log in via an institution to check access.
References
Cotton RT (1985) Prevention and management of laryngeal stenosis in infants and children. J Pediatr Surg 20:845–851
White DR, Cotton RT, Bean JA, Rutter MJ (2005) Pediatric cricotracheal resection: surgical outcomes and risk factor analysis. Arch Otolaryngol Head Neck Surg 131:896–899
George M, Ikonomidis C, Jaquet Y, Monnier P (2009) Partial cricotracheal resection in children: potential pitfalls and avoidance of complications. Otolaryngol Head Neck Surg 141:225–231. doi:10.1016/j.otohns.2009.04.019
Fearon B, Cotton R (1972) Surgical correction of subglottic stenosis of the larynx. Preliminary report of an experimental surgical technique. Ann Otol Rhinol Laryngol 81:508–513
Cotton RT, Seid AB (1980) Management of the extubation problem in the premature child. Anterior cricoid split as an alternative to tracheotomy. Ann Otol Rhinol Laryngol 89:508–511
Zaima A, Bitoh Y, Morita K, Tsugawa J, Ishii T, Satoh S, Nishijima E (2010) Long-term T-tube stenting as definitive treatment of severe acquired subglottic stenosis in children. J Pediatr Surg 45:996–999
Hartley BE, Cotton RT (2000) Paediatric airway stenosis: laryngotracheal reconstruction or cricotracheal resection? Clin Otolaryngol Allied Sci 25:342–349
Myer CM 3rd, O’Connor DM, Cotton RT (1994) Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 103:319–323
Monnier P, Ikonomidis C, Jaquet Y, George M (2009) Proposal of a new classification for optimising outcome assessment following partial cricotracheal resections in severe pediatric subglottic stenosis. Int J Pediatr Otorhinolaryngol 73:1217–1221. doi:10.1016/j.ijporl.2009.05.008
Yamamoto K, Monnier P, Holtz F, Jaquet Y (2014) Laryngotracheal reconstruction for pediatric glotto-subglottic stenosis. Int J Pediatr Otorhinolaryngol 78:1476–1479. doi:10.1016/j.ijporl.2014.06.012
George M, Jaquet Y, Ikonomidis C, Monnier P (2010) Management of severe pediatric subglottic stenosis with glottic involvement. J Thorac Cardiovasc Surg 139:411–417. doi:10.1016/j.jtcvs.2009.05.010
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Rights and permissions
About this article
Cite this article
Morita, K., Yokoi, A., Bitoh, Y. et al. Severe acquired subglottic stenosis in children: analysis of clinical features and surgical outcomes based on the range of stenosis. Pediatr Surg Int 31, 943–947 (2015). https://doi.org/10.1007/s00383-015-3773-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-015-3773-1