Strategy for surgical treatment of congenital subglottic stenosis in children

Abstract

Background/purposeCongenital subglottic stenosis is a rare anomaly caused by thickened cricoid cartilage. We report our surgical techniques, comprising anterior cricoid split (ACS), laryngotracheoplasty (LTP), KTP laser ablation, and application of a tracheal opening retainer (TOR) into the tracheostomy site.MethodsNine patients have been treated since 1988. Four patients (median age 85 days; range 5 days to 6 months) underwent ACS. Another four patients (median age, 17 months; range, 5–57 months) underwent LTP using costal cartilage grafts, although two had undergone tracheostomy before LTP. One patient underwent LTP, ablation of the projecting part of the cricoid cartilage with KTP laser (LTP + Laser) and, preservation of the tracheal opening by placement of the TOR.ResultsAll ACS and LTP patients were successfully extubated at a median of 32 days (range 23–91 days) and 23 days (range 6–31 days) postoperatively, respectively. The LTP + Laser patient was extubated 35 days after surgery and the TOR was removed asymptomatically 20 days after extubation of the stent tube.ConclusionsAnterior cricoid split is useful for patients ≤6 months old and LTP is useful for patients >6 months old and/or with tracheostomy. KTP laser ablation is effective to remove thickened parts of cricoid cartilage protecting the vocal cords. The tracheal opening preserved by the TOR works as an additional channel to safeguard respiration during the extubation process.

Flexible Laryngoscopy in Management of Congenital Stridor

“…Membranous congenital SGS is more common than cartilaginous stenosis [14,15]. Treatment options available are endoscopic release, and open surgical procedure like cricotracheal resection and anastomosis and laryngotracheoplasty [16,17]. In this study, both the patients had grade 3 membranous stenosis and both were managed endoscopically using laser.…”

Validation of Animal Models for Simulation Training in Pediatric Laryngotracheal Reconstruction

“…The lack of consensus on validation protocols has resulted in significant heterogeneity of methodology, participant enrolment and statistical analysis of data in published literature for otolaryngology simulation. 15…”

“…The lack of consensus on validation protocols has resulted in significant heterogeneity of methodology, participant enrolment and statistical analysis of data in published literature for otolaryngology simulation. 15 In order to limit interobserver variability and identify the most suitable model, we conducted a simultaneous comparison of FV and CV of different animal models by the same participant. To our knowledge this is the first published example of a synchronous trimodel comparative validation assessment of animal models in pediatric otolaryngology.…”

A systematic review of simulated laryngotracheal reconstruction animal models

“…In this patient cohort we would recommend grafting techniques are utilized where possible; however, these procedures may not be feasible due to infant size. In this group, anterior cricoid split as a sole treatment modality may be the most suitable expansion procedure, and because of this, the rabbit model may not reflect an appropriate clinical model for simulating grafting techniques . Furthermore, although the laryngotracheal anatomy is largely similar in the rabbit, the thin cricoid cartilage, the long cricothyroid distance, and the dissimilarity of cartilage graft material makes graft insertion difficult during LTR .…”

“…In this group, anterior cricoid split as a sole treatment modality may be the most suitable expansion procedure, and because of this, the rabbit model may not reflect an appropriate clinical model for simulating grafting techniques. 28,[57][58][59] Furthermore, although the laryngotracheal anatomy is largely similar in the rabbit, the thin cricoid cartilage, the long cricothyroid distance, and the dissimilarity of cartilage graft material makes graft insertion difficult during LTR. 23,35,40 Due to these factors, rabbit models may be less suited to anterior and posterior grafting techniques, and larger animals with more similar anatomy would be preferred to simulate these procedural steps.…”