Pediatric Laryngotracheal Stenosis Management: 10 Years’ Experience at the Hacettepe University Otorhinolaryngology Department

Abstract

Objectives: Analyze surgical treatment modalities for pediatric laryngotracheal stenosis. Methods: We retrospectively reviewed patients that underwent laryngotracheal surgery for stenosis between 2002 and 2012. Age, sex, etiologic factors, stenosis grades, comorbidities, surgical techniques, decannulation rates, and complications were evaluated. There were subglottic stenosis (SGS), posterior glottis stenosis (PGS), and tracheal stenosis (TS). Surgical details and outcomes were examined for endolaryngeal procedures, laryngotracheal reconstruction (LTR), partial cricotracheal resection (PCTR), and tracheal resection (TR). Results: There were 44 patients. Prolonged intubation because of trauma was the leading primary cause of stenosis. Congenital stenosis and congenital heart disease operations were also present frequently. There were 20 LTRs, 13 endolaryngeal balloon dilatation, 7 PCTRs, and 4 TRs. Decannulation was successfully accomplished in 27 of 32 patients (84%). Overall success rate in airway management was 91% (40/44). Restenosis was observed after 8 LTRs and 2 PCTRs. Major complications were bilateral recurrent nerve paralysis, postoperative death due to sepsis, and accidental extubation with an overall rate of 6% (3/44). Conclusions: Pediatric airway surgery needs good multidisciplinary cooperation. Correct indication and precise surgical technique are important factors in determining the results. Endolaryngeal procedures should be performed only for membranous and/or low grade stenosis cases, otherwise they cause more tissue damage, leading to fibrosis that complicates the pathology. LTR with anterior and/or posterior grafting is suitable for grade II and III stenosis, while PCTR should be the first choice of treatment for grade IV stenosis. Open surgical procedures should be performed as a single stage surgery if possible.