Laryngotrachéoplastie avec quadrisection du cartilage cricoïde chez l’enfant

Abstract

Four-quadrant cricoid division in laryngotracheal reconstruction is indicated in case of very tight laryngotracheal stenosis. The principle of this operation is to section the anterior, posterior and lateral walls of the cricoid and to increase the diameter of the laryngeal lumen by interposition of a cartilaginous graft in the anterior and/or posterior cricoid wall. From 1991 to 2001, 25 children underwent a laryngotracheoplasty with four-quadrant cricoid division. Two techniques were used: a single-stage procedure with a 10 days post-operative intubation (n=6), or a two-stage procedure with prolonged post-operative intraluminal stenting and tracheostomy (n=19). In the two-stage procedure the decannulation rate was 89% (17/19) after the first operation, and 100% after revision surgery using the same technique. In the single-stage procedure the extubation rate was 83.3% (5/6). Laryngotracheal reconstruction with four-quadrant cricoid division gives excellent airway patency especially in case of severe subglottic stenosis with altered laryngeal mobility. The single-stage procedure decreased the tracheostomy related morbidity. This technique is particularly adapted to children under three.