Abstract
Objectives: Treatment of pediatric congenital or acquired subglottic stenosis (SG), in contrast to previous practices, has been performed at our institution since 1998 with either rib cartilage graft laryngotracheoplasty (LTP) or cricotracheal resection (CTR). The purpose was to analyze the recent experience of our pediatric laryngotracheal reconstruction program.
Methods: Four-year (1998–2001) retrospective chart review of children with SG consecutively operated by open laryngotracheal reconstruction at the Division of Pediatric Otolaryngology of a tertiary academic referral hospital in the north of Portugal. The main outcome measures were decan-nulation and return to a non-restrained lifestyle.
Results: From 194 diagnostic laryngotracheoscopies performed, 10 patients were operated for the single diagnosis of SG. Ages ranged from 2 to 18 years with 54% girls. Lesions were distributed by Cotton-Myer's grades II (n = 2), III (n = 6), and IV (n = 3). Types of surgery included single-stage LTP (n = 3), two-stage LTP (n = 5), primary CTR (n = 2), and salvage CTR (n = 1). All children were successfully decannulated, nine after the first surgery and one following salvage CTR. No recurrent laryngeal nerve lesions occurred. Residual stridor or exertional dyspnea was not registered within a minimum follow-up of 1 year. Voice quality remained good in nine patients.
Conclusion: The results support the use of open laryngotracheal surgery for the treatment of pediatric SG. Grade II and III lesions can be capably treated with either single- or two-stage costal cartilage graft LTP. Grade IV stenosis should preferentially be managed by CTR which is also a good alternative for salvage surgery. Despite the small size of our series, the 100% decannulation rate is very stimulating to proceed with these challenging procedures.