Endoscopic Posterior Cricoid Expansion in Children

Abstract

Objective: To review our experience with endoscopic posterior cricoid split and costal cartilage graft placement in the management of pediatric bilateral vocal fold immobility (BVFI), posterior glottic stenosis (PGS), and subglottic stenosis (SGS). Method: Multi-institutional retrospective case series of all patients treated with endoscopic posterior cricoid split and costal cartilage graft placement (EPCSCG) by any of the authors. Outcomes measured include: indications, complications, outcome. Results: Twenty-six patients underwent EPCSCG. Age range at time of surgery was 1 month to 15 years. Overall, there was an excellent success rate with 25/26 either never requiring tracheostomy or achieving decannulation and 24/26 having adequate symptom control. The mean follow-up was 23.15 months. Sixteen patients had resolution of their symptoms. Fourteen patients had SGS in isolation or in combination with cricoarytenoid fixation, glottic stenosis or vocal fold immobility. Thirteen achieved decannulation and/or had resolution of preoperative symptoms. Three patients had isolated PGS or cricoarytenoid fixation with 2 achieving decannulation without additional procedures and the third decannulated after revision endoscopic division of a congenital anterior glottic web. Nine patients had isolated BVFI. Two of the 9 had failed prior laryngeal surgeries and 4 did not have tracheostomies at the time of their EPCSCG. Of these 9 patients, 7 had resolution of their airway symptoms without additional procedures. Conclusion: Based on this experience, EPCSCG is worth consideration for the management of select pediatric patients with BVFI, PGS, and SGS.