Abstract
Background
We have reviewed the surgical procedures performed and outcomes for low-birth-weight infants with acquired subglottic stenosis.
Methods
The gestational age at birth, birth weight, age at Laryngotracheal reconstruction, and therapeutic outcome over the past 26 years were reviewed. Laryngotracheal reconstruction was initially performed by costochondral grafting involving only the anterior wall for the first operation, but since 2010 a costal cartilage was also inserted into the posterior wall of the cricoid cartilage using the BENSON pylorus spreader to split the cartilage.
Results
There were 21 patients. The mean gestational age was 29.6 weeks, the mean birth weight was 1127 g, and the first surgery was performed at a mean age of 37.0 ± 21.8 months. Extubation was possible in 11 of 21 patients (52.3%) after the first surgery and in 7 of 7 patients after re-operation. The total extubation rate reached 100% (18/18) excluding three patients (one who suffered sudden death, and two who were lost to follow-up).
Conclusion
Sufficient dilatation of the subglottic space could not be achieved by costochondral grafting involving the anterior wall alone. The extubation rate was improved by dilatation of the posterior wall and the insertion of costal cartilage into both the anterior and posterior walls.
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References
Santos D, Mitchell R (2010) The history of pediatric airway reconstruction. Laryngoscope 120(4):815–820
Holinger LD, Stankiewicz JA, Livingston GL (1987) Anterior cricoid split: the Chicago experience with an alternative to tracheotomy. Laryngoscope 97(1):19–24
Eze NN, Wyatt ME, Hartley BE (2005) The role of the anterior cricoid split in facilitating extubation in infants. Int J Pediatr Otorhinolaryngol 69(6):843–846
Rotenberg BW, Berkowitz RG (2006) Changing trends in the success rate of anterior cricoid split. Ann Otol Rhinol Laryngol 115(11):833–836
Agrawal N, Black M, Morrison G (2007) Ten-year review of laryngotracheal reconstruction for paediatric airway stenosis. Int J Pediatr Otorhinolaryngol 71(5):699–703
Marom T, Joseph RA, Grindle CR, Shah UK (2014) Tracheostomy after laryngotracheoplasty: risk factors over 10 years. J Pediatr Surg 49(8):1206–1209
Myer CM, O’Connor DM, Cotton RT (1994) Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 103(4 Pt 1):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(9):1217–1221
Morita K, Yokoi A, Bitoh Y, Fukuzawa H, Okata Y, Iwade T, Endo K, Takemoto J, Tamaki A, Maeda K (2015) 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
Smith LP, Zur KB, Jacobs JN (2010) Single- vs double-stage laryngotracheal reconstruction. Arch Otolaryngol Head Neck Surg 136(1):60–65
Younis RT, Lazar RH, Astor F (2003) Posterior cartilage graft in single stage laryngotracheal reconstruction. Otolaryngol Head Neck Surg 129(3):168–175
Koltai PJ, Ellis B, Chan J, Calabro A (2006) Anterior and posterior cartilage graft dimensions in successful laryngotracheal reconstruction. Arch Otolaryngol Head Neck Surg 132(6):631–634
Gustafson LM, Hartley BE, Liu JH, Chadwell J, Koebbe C, Myer CM 3rd, Cotton RT (2000) Single-stage laryngotracheal reconstruction in children: a review of 200 cases. Otolaryngol Head Neck Surg 123(4):430–434
Zalzal GH (1993) Treatment of laryngotracheal stenosis with anterior and posterior cartilage grafts. A report of 41 children. Arch Otolaryngol Head Neck Surg 119(1):82–86
Schmidt RJ, Shan G, Sobin L, Reilly JS (2011) Laryngotracheal reconstruction in infants and children: are single-stage anterior and posterior grafts a reliable intervention at all pediatric hospitals? Int J Pediatr Otorhinolaryngol 75(12):1585–1588
Younis RT, Lazer RH, Astor F (2003) Posterior cartilage graft in single-stage laryngotracheal reconstruction. Otolaryngol Head Neck Surg 129(3):168–175
Acknowledgements
The authors thank to Professor Kevin Pringle in Department of Obstetrics and Gynecology, School of Medicine & Health Sciences, University of Otago, Wellington, New Zealand for his help with English editing for this manuscript.
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Furuta, S., Nagae, H., Ohyama, K. et al. Therapeutic effectiveness of costal cartilage grafting into both anterior and posterior walls for laryngotracheal reconstruction in acquired subglottic stenosis. Pediatr Surg Int 37, 555–559 (2021). https://doi.org/10.1007/s00383-020-04812-y
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DOI: https://doi.org/10.1007/s00383-020-04812-y