Anterior cricoid split for subglottic stenosis: Experience at the children's hospital of new jersey

Palasti, Sandra; Respler, Don S.; Levitt, Joel

doi:10.1288/00005537-199209000-00008

Cited by 18 publications

(1 citation statement)

References 20 publications

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“…The choice to forego graft placement in LTR should be approached with caution. Although these techniques were historically the driving force behind LTR in children, 22 there has been growing evidence that interposition grafting based on the location of stenosis leads to higher rates of decannulation. [23][24][25][26] Our cohort is no exception.…”

Section: Discussionmentioning

confidence: 99%

Recalcitrant Stenosis Following Pediatric LTR: Contributing Factors and Clinical Impact

Blumenthal,

Leonard,

Behzadpour

et al. 2024

Otolaryngol.--head neck surg.

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ObjectivesLaryngotracheal reconstruction (LTR) has revolutionized the management of pediatric subglottic stenosis (SGS). However, postoperative stenosis remains a difficult hurdle to overcome. Our goal is to determine the clinical impact of recalcitrant stenosis after LTR and the factors contributing to postoperative stenosis.Study DesignRetrospective review of 181 open LTR patients between 2008 and 2021.SettingStand‐alone tertiary children's hospital.MethodsRecalcitrant stenosis was defined as new or worsening stenosis despite open LTR. Fisher's exact and Mann‐Whitney tests were used to detect differences in categorical and continuous clinical data between patients with and without treatment‐resistant stenosis. Time‐to‐decannulation analysis of both groups was performed using Kaplan‐Meier analysis and evaluated with log‐rank and Cox proportional hazards regression. Multivariate logistical regression was used to assess the validity of associations found in univariate analysis.ResultsAs expected, the 27 patients with postoperative stenosis were less likely to be decannulated (P < .001, Fisher's Exact), more likely to require a postoperative tracheostomy (P < .001, Fisher's Exact) or revision LTR (P < .001, Fisher's Exact) and had prolonged time to decannulation (P < .001, Log‐rank). Children with Grade IV SGS (P = .004, Fisher's Exact), and those with longer suprastomal stent duration (P = .03, Fisher's Exact) were more likely to suffer from recalcitrant stenosis. Stent duration longer than 4 weeks (P = .01) contributed to refractory stenosis when controlling for all aforementioned variables using multivariable logistic regression. Interposition grafts had a protective effect (P = .005).ConclusionMaintaining suprastomal stents over 4 weeks after LTR increases the risk for postoperative stenosis and its sequelae.Level of Evidence4

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Section: Discussionmentioning

confidence: 99%

Recalcitrant Stenosis Following Pediatric LTR: Contributing Factors and Clinical Impact

Blumenthal,

Leonard,

Behzadpour

et al. 2024

Otolaryngol.--head neck surg.

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Problems in Postoperative Management After Anterior Cricoid Split

Tavin

Singer²,

Bassila³

1994

Archives of Otolaryngology - Head and Neck Surgery

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A Novel Endoscopic Anterior Cricoid Rib Grafting: A Feasibility Study in An Animal Model

Aldriweesh,

Almutairi,

Alshareef

et al. 2024

OTO Open

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ObjectiveThe objective of our study was to document the feasibility of a novel endoscopic anterior cricoid split and rib grafting technique in a goat airway model.Study DesignFeasibility pilot animal study.SettingAnimal surgical laboratory at a tertiary hospital and research center.MethodsThree Ardhi goats were utilized. After harvesting and shaping the rib graft, 2 sutures were inserted transversely into the graft. An endoscopic midline anterior cricoid split was performed and extended down through the first tracheal ring, followed by a balloon dilation of the site. Next, the 2 lower and upper graft suture ends were sequentially passed as endo‐extra laryngeal sutures and tied on the anterior neck skin. Laryngeal stent was utilized in 1 goat following graft placement.ResultsThe surgery was successful in all included animals and bronchoscopy performed 7 days after surgery, revealed that the anterior graft was in good position. One goat developed surgical site infection leading to partial graft resorption.ConclusionThis study demonstrated the feasibility of this novel procedure which is potentially useful for patients who are candidates for a single‐stage reconstruction. Future studies should investigate the safety and validity of this technique in a model with subglottic stenosis.Level of EvidenceNA

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Anterior cricoid split for subglottic stenosis: Experience at the children's hospital of new jersey

Cited by 18 publications

References 20 publications

Recalcitrant Stenosis Following Pediatric LTR: Contributing Factors and Clinical Impact

Recalcitrant Stenosis Following Pediatric LTR: Contributing Factors and Clinical Impact

Problems in Postoperative Management After Anterior Cricoid Split

A Novel Endoscopic Anterior Cricoid Rib Grafting: A Feasibility Study in An Animal Model

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