Slide laryngotracheoplasty for congenital subglottic stenosis in newborns and infants

Abstract

Objectives Subglottic stenosis is the most common laryngeal anomaly necessitating tracheostomy in early childhood. Crico‐ and laryngotracheal resection and laryngotracheal reconstruction—usually with autologous cartilage graft implantation—are the most effective treatments. These surgical techniques are obviously challenging in neonatal age and infancy. However, a reconstructive surgery performed at early age may prevent the sequel of complications. Methods The authors present their novel surgical method for congenital subglottic stenosis. Seven infants had inspiratory stridor; two of them had to be intubated and one required tracheostomy. Laryngotracheoscopy, CT or MRI revealed subglottic stenosis: Cotton‐Myer grade II in one, and grade III in six cases. Slide laryngotracheoplasty was performed before 5 months of age (10–130 days), with a follow‐up period of average 36 months (4–80 months). Phoniatry and quality of life questionnaire were used for evaluation of postoperative results. Results Slide laryngotracheoplasty in the neonatal age made the temporary tracheostomy unnecessary. All babies remained intubated for 3 to 10 days with an uncuffed tracheal tube. After extubation, no dyspnea or swallowing disorder occurred. A subjective quality of life questionnaire, laryngotracheoscopy, clinical growth charts showed satisfactory functional results. Conclusions Single‐stage slide laryngotracheoplasty might be a favorable solution for subglottic stenosis, even in early childhood. In one step, the airway can be maintained without stenting and tracheostomy. Level of Evidence 4 Laryngoscope, 130:E199–E205, 2020

Idiopathic subglottic stenosis with an inguinal hernia in children: A case report

“…Nonetheless, it is the most common laryngeal anomaly in infants under the age of one receiving tracheotomy. [15] In our case, the patient had no prior history of endotracheal intubation, and the cause of the tracheal stenosis was unclear. Inguinal hernia is a clinical condition resulting from the inadequate or delayed fusion of the processus vaginalis, warranting surgery.…”

“…[1] Endoscopy enables the determination of the location, scope, and complexity of iSGS. Concentric reticular stenosis <1 cm in length is termed “simple,” whereas stenosis with structural abnormalities is “complex.” [1,15] In this instance, the stenosis was referred to as “simple” stenosis. Endoscopic treatment may be considered for patients with “simple” concentric reticular stenosis that does not affect the cartilage, whereas complicated lesions require surgical repair.…”

Single stage cricoid split laryngoplasty with costochondral rib grafting is a novel approach to treat subglottic stenosis in a paediatric patient: A case report

“…There are various procedures available for laryngotracheal reconstruction (LTR), partial cricotracheal resection (PCTR), and extended cricotracheal resection (ECTR). All these interventions are highly invasive and remove a significant amount of tissue from the larynx and/or trachea, which calls for the need for replacement by stenting or grafting [ 7 ]. This case was planned for “Cervical Tracheoplasty” but changed in favor of “Cricoid Split Laryngoplasty” involving costochondral rib grafting.…”

Neonatal Airway Abnormalities

“…Open reconstructive procedures, such as laryngotracheal reconstruction with cartilage grafting, may be necessary to expand the airway of patients with high-grade stenoses. Slide tracheoplasty has been discussed in very young infants as a single-stage procedure to treat stenosis without the need for temporary tracheostomy, but series are limited [ 34 ].…”