We sought to describe our experience in the management of complex glotto-subglottic stenosis in the pediatric age group.
METHODS:
Between 1978 and 2008, 33 children with glotto-subglottic stenosis underwent partial cricotracheal resection, and they form the focus of this study. They were compared with 67 children with isolated subglottic stenosis (no glottic involvement). The outcomes measured were need for revision open surgical intervention, delayed decannulation (>6 months), and operation-specific and overall decannulation rates. Fisher's exact test was used for comparison of outcomes.
RESULTS:
Results of preoperative evaluation showed Myer-Cotton grade III or IV stenosis in 32 (97%) patients and grade II stenosis in 1 patient. All patients with glotto-subglottic stenosis were treated with partial cricotracheal resection and simultaneous repair of the glottic pathology. Bilateral fixed vocal cords were seen in 19 (58%) of 33 patients, bilateral restricted abduction was seen in 7 (21%) of 33 patients, and unilateral fixed vocal cord was seen in 7 (21%) of 33 patients. Ten patients underwent single-stage partial cricotracheal resection with excision of interarytenoid scar tissue. The endotracheal tube was kept for a mean period of 7 days as a stent. Twenty-three patients underwent extended partial cricotracheal resection with LT-Mold (Bredam S.A., St. Sulpice, Switzerland) or T-tube stenting. The overall decannulation rate included 26 (79%) patients, and the operation-specific decannulation rate included 20 (61%) patients.
CONCLUSIONS:
Glotto-subglottic stenosis is a complex laryngeal injury associated with delayed decannulation and decreased overall and operation-specific decannulation rates when compared with those after subglottic stenosis without glottic involvement after partial cricotracheal resection.
Management of severe pediatric subglottic stenosis with glottic involvement.
J Thorac Cardiovasc Surg. 2009 Jun 30; George M, Jaquet Y, Ikonomidis C, Monnier P (Hubmed.org)
Related:
Endoscopic management of subglottic stenosis
Noisy breathing: overview of subglottic stenosis in children
Subglottic stenosis in pregnancy
Chondrodysplasia Punctata and Subglottic Stenosis
Nonneoplastic nontraumatic subglottic stenosis
The management of laryngeal and subglottic stenosis
Balloon laryngoplasty as a primary treatment for subglottic stenosis
Subglottic Stenosis Complicating Cardiac Surgery in Children
Adult Subglottic Stenosis: Management With Laser Incisions
subglottic stenosis dilation
METHODS:
Between 1978 and 2008, 33 children with glotto-subglottic stenosis underwent partial cricotracheal resection, and they form the focus of this study. They were compared with 67 children with isolated subglottic stenosis (no glottic involvement). The outcomes measured were need for revision open surgical intervention, delayed decannulation (>6 months), and operation-specific and overall decannulation rates. Fisher's exact test was used for comparison of outcomes.
RESULTS:
Results of preoperative evaluation showed Myer-Cotton grade III or IV stenosis in 32 (97%) patients and grade II stenosis in 1 patient. All patients with glotto-subglottic stenosis were treated with partial cricotracheal resection and simultaneous repair of the glottic pathology. Bilateral fixed vocal cords were seen in 19 (58%) of 33 patients, bilateral restricted abduction was seen in 7 (21%) of 33 patients, and unilateral fixed vocal cord was seen in 7 (21%) of 33 patients. Ten patients underwent single-stage partial cricotracheal resection with excision of interarytenoid scar tissue. The endotracheal tube was kept for a mean period of 7 days as a stent. Twenty-three patients underwent extended partial cricotracheal resection with LT-Mold (Bredam S.A., St. Sulpice, Switzerland) or T-tube stenting. The overall decannulation rate included 26 (79%) patients, and the operation-specific decannulation rate included 20 (61%) patients.
CONCLUSIONS:
Glotto-subglottic stenosis is a complex laryngeal injury associated with delayed decannulation and decreased overall and operation-specific decannulation rates when compared with those after subglottic stenosis without glottic involvement after partial cricotracheal resection.
Management of severe pediatric subglottic stenosis with glottic involvement.
J Thorac Cardiovasc Surg. 2009 Jun 30; George M, Jaquet Y, Ikonomidis C, Monnier P (Hubmed.org)
Related:
Endoscopic management of subglottic stenosis
Noisy breathing: overview of subglottic stenosis in children
Subglottic stenosis in pregnancy
Chondrodysplasia Punctata and Subglottic Stenosis
Nonneoplastic nontraumatic subglottic stenosis
The management of laryngeal and subglottic stenosis
Balloon laryngoplasty as a primary treatment for subglottic stenosis
Subglottic Stenosis Complicating Cardiac Surgery in Children
Adult Subglottic Stenosis: Management With Laser Incisions
subglottic stenosis dilation
