Pediatric Open Airway Reconstruction

Abstract

Subglottic stenosis (SGS) and tracheal stenosis (TS) can be congenital or acquired. Ongoing improvements in neonatal care have led to an increased number of infants with prolonged intubation and tracheostomy. Both of these interventions have led to an increase in SGS and TS and management of these lesions can be challenging. A wide array of endoscopic and open techniques exist to manage these issues. This article aims to review previous and current literature on open airway reconstruction to guide care for these children. Experience and expertise in airway surgery have shifted recent research towards non-airway outcome measures such as swallowing and voice, though the primary treatment objective remains decannulation. Various open surgical options as slide tracheoplasty, laryngotracheal reconstruction, and partial cricotracheal resection and anastomosis are available for correcting laryngotracheal stenosis. The choice of the surgery should be based on demography and characteristics of the stenosis found during endoscopy and the associated comorbidities of the patient. Open airway reconstruction for treatment of LTS is effective but careful preoperative evaluation and patient selection are important. Ongoing research focuses on improving swallowing and voice outcomes.