Four-quadrant cricoid cartilage division in laryngotracheal reconstruction : Cotton R.T.; Mortelliti A.J.; Myer C.M. IIIARCH. OTOLARYNGOL. HEAD NECK SURG. (1992) 118/10 (1023–1027)

Abstract

Upper airway stenosis (UAS) after endotracheal intubation is a common problem in children. Most literature refers to a surgical treatment for these lesions. Laryngotracheal reconstruction and cricotracheal resection are used for low- and high-grade stenosis, but decannulation is not always possible immediately after surgery.The aim of this study was to verify the feasibility and results of endoscopic dilatations for treatment of subglottic stenosis.The study encompassed a 12-year retrospective analysis of patients treated for UAS in a tertiary center. All children were symptomatic at the time of the endoscopic diagnosis. The stenosis was graded according to the Myer-Cotton criteria. Endoscopic dilatation was initiated immediately after the diagnosis. Children with grade IV stenosis underwent surgery.Children with tracheal stenosis and no involvement of the subglottic area did not respond to endoscopic dilatations and underwent surgery. There were 45 children with grade I stenosis, 12 with grade II, 7 with grade III, and 4 with grade IV lesions. Patients with grade I, II, and III stenosis were all treated by endoscopic dilatations alone and were decannulated when asymptomatic. The average time for decannulation was 18.90 ± 26.07 months for grade I, 32.5 ± 27.08 months for grade II, and 27.57 ± 20.60 months for grade III stenosis (P < .01, for grade II vs grade III).Grade I, II, and III subglottic stenoses can be safely managed by early endoscopic dilatations with a high rate of success and low rate of morbidity but require a significantly long period of treatment.