Primary Cricotracheal Resection with Thyrotracheal Anastomosis for the Treatment of Severe Subglottic Stenosis in Children and Adolescents

Abstract

Severe subglottic stenosis in children is best managed by laryngotracheal reconstruction or cricotracheal resection (CTR). We describe clinical outcomes with CTR and end-to-end anastomosis in pediatric patients with severe subglottic stenosis in a tertiary-care pediatric teaching hospital in Mexico City. We prospectively followed up all consecutive patients younger than 18 years of age with a Myer-Cotton grade 3 or 4 subglottic stenosis who underwent CTR between May 1, 2000, and March 31, 2003. The frequency of each clinical outcome was calculated. Twenty-two patients (16 boys [72.7%] and 6 girls [27.3%]) were included. The mean age at operation was 4.6 years (range, 11 months to 16 years). Eighteen patients (81.8%) required primary CTR, and 4 (18.2%) required extended CTR. Seventeen (77.3%) had grade 3 stenosis, and 5 (22.7%) had grade 4 stenosis. Six (27.3%) had associated clinical conditions, and 3 (13.6%) had associated vocal cord mobility defects. All were tracheostomy-dependent at presentation, and none had undergone previous airway surgery. Ten (45.5%) underwent one-stage surgery, and 12 (54.5%) had a concomitant temporary tracheotomy. No intraoperative complications occurred. Seventeen patients (77.3%) developed postoperative granulation tissue requiring endoscopic resection. The mean follow-up was 1.2 years (range, 2 months to 2.8 years). No deaths occurred. Fifteen children (88.2%) with grade 3 stenosis and 5 (100%) with grade 4 stenosis were decannulated, for an overall decannulation rate of 90.9%. Partial cricoid resection with end-to-end anastomosis has been a feasible procedure with reproducible successful results among our patients. We conclude that CTR performed as a primary procedure is an effective treatment for the management of severe subglottic stenosis in children.

Slide thyrocricotracheoplasty for the treatment of high-grade subglottic stenosis in children

“…In the last patient (patient 5), the primary problem was not with the anastomosis but rather resulted from luminal bulging growth of granulation tissue growing from the closed site of the previous tracheostomy. Thus, although the number of patients in our series was small, the anastomosis was found to be intact in all patients with the exception of one (MRSA infection) and the overall decannulation rate was 100% after slide thyrocricotracheoplasty, which is actually higher than other series reporting postoperative decannulation rate in patients with high-grade SGS [9,[13][14][15][16][17]. This high success rate of overall decannulation in our study can be explained by several advantages specific to slide-type reconstruction.…”

Partial cricotracheal resection with tracheal intussusception and cricoarytenoid joint mobilization: Early experience in a new technical variant

“…The technique of partial cricotracheal resection (PCTR) involves the resection of the anterior cricoid arch and thinning of the posterior cricoid plate with preservation of a posterior membranous tracheal mucosal flap. The transected normal trachea is then telescoped into the posterior cricoid plate and anastomosed to the thyroid cartilage 2–4. Extended PCTR is performed in patients with an additional glottic pathology (posterior glottic stenosis or vocal cord synechiae).…”

Outcomes of early infancy laryngeal reconstruction on health- and voice-related quality of life

“…However, the long term effects of the ACS in relation to growth and function of the larynx remain poorly understood. A number of studies have already examined the outcome of LTR in terms of avoidance of tracheotomy or successful decanulation or both [4][5][6][7]. However, follow-up studies on the effect of early laryngeal surgery on the voice as well as on voice-related quality of life (VRQoL) and health-related quality of life (HRQoL) are scarce in the medical literature.…”