Outcomes of Pediatric Posterior Graft Laryngotracheoplasty

Abstract

Objective 1) Determine the operation specific decannulation rate of patients who required posterior costal cartilage grafting (PCCG) in the management of laryngeal stenosis. 2) Describe the complications associated with PCCG laryngotracheoplasty. 3) Describe voice outcomes for selected patients. Methods A retrospective review was performed on all cases of posterior graft laryngotracheoplasty (LTP) performed by the 2 senior authors over a 9-year period at a tertiary care children's hospital. Results There were 42 total patients. The operation specific decannulation rates were 100% (3/3) for Myer-Cotton grade II SGS, 75% (20/26) for grade III, and 60% (3/5) for grade IV. For posterior glottic stenosis (PGS), it was 57% (4/7) and for PGS with grade II SGS, it was 60% (6/10). There was no significant difference (p=0.727) among these groups. The overall decannulation rates were 100% (3/3), 96% (25/26), and 100% (5/5) for Myer-Cotton grades II, III and IV. For PGS, it was 83% (5/6), and for PGS with grade II SGS, it was 100% (8/8). There was no significant difference (p=0.527) among these groups. The relative risk for complications was higher among children who had a sutured vs. a sutureless posterior graft (RR= 2.7, p<.01). The most commonly seen compensatory vocal behavior was supraglottic dysphonia. Conclusions Operation-specific decannulation rates are not significantly different with increasing disease severity, although the power to detect small differences in this study is low. PCCG via a sutureless technique is associated with a lower complication rate. Supraglottic dysphonia is a common compensatory vocal behavior after PCCG LTP.