Modified Minerva Orthosis for Postoperative Management of Cricotracheal Resection in Children

Abstract

ABSTRACT Introduction Cricotracheal resection (CTR) and tracheal resection (TR) are open surgical options to treat airway stenoses. One of the most devastating complications is anastomosal dehiscence, owing to excessive tension on the anastomosis from cervical extension. To prevent excessive tension on the anastomosis during the postoperative period, the neck is kept in a neutral or slightly flexed position. We describe a novel design and fitting of a modified pediatric Lerman Minerva cervical-thoracic orthosis (CTO) in our pediatric patient population after CTR or TR to protect the anastomosis. Method A Minerva CTO is customized to reduce anastomotic tension. The mandibular extension is removed, occipital extension is recontoured, plastic is trimmed, and a perineal strap is added. The orthosis allows avoidance/removal of the manubrial-mandibular suture, reducing skin complications and increasing mobilization. Discussion This modified Minerva CTO provided three key benefits: it can be sized down to fit small children, provides the desired immobilization, and is adjustable during fitting to ensure that the angle of cervical flexion is appropriate to protect the anastomosis. Conclusion After CTR and TR, proper cervical positioning is crucial to avoid tension on the anastomosis. Our novel modification of the Minerva orthosis is a useful adjunct in the postoperative management of these patients. Clinical relevance This modified pediatric Lerman Minerva CTO is a useful adjunct to protect the anastomosis following CTR or TR.