Acquired laryngotracheal stenosis in chidlren

Abstract

Twenty children with iatrogenic laryngotracheal stenosis were presented. All patients were under 12, with all but four under 5 yr of age. Tracheostomy was the preceding procedure in six and prolonged nasotracheal intubation in 14 patients. This complication occurred in 2.3% of the tracheostomized and in 0.9% of the intubated patients of the intensive care unit. Bouginage with or without endoscopic removal of granulation tissue had satisfactory results in nine patients. In two children tracheal resection was performed with good results. Seven patients with cricoidal stenosis were successfully operated upon through the laryngofissure by excising the scar and dividing the cricoid cartilage posteriorly. The diastasis thus achieved was kept open with a teflon prosthesis left in place for 4 mo. A similar procedure under cardiopulmonary bypass was performed in one infant with long precarinal stenosis, but this patient died of hyperkalemic cardiac arrest. Another patient died of pneumonia during the course of intermittent dilatation treatment. A mortality of 10% and an average hospitalization time of 7.7 mo reflect the serious nature of this disease. Every effort should be used to prevent it.