Primary partial cricoid resection with thyrotracheal anastomosis in pediatric population

Abstract

Objectives: To describe clinical outcomes with the partial cricoid resection and termino-terminal anastomosis technique in pediatric patients with severe subglottic stenosis in a tertiary care pediatric teaching hospital in Mexico City. Methods: Prospective follow-up of all consecutive patients with a Myer-Cotton′s stage III or IV subglottic stenosis who underwent this procedure between May 1, 2000 and March 31, 2003. Simple calculation of frequencies for each clinical outcomes was done. Results: Twenty-two patients, 16 (72.7%) boys and 6 (27.3%) girls were included. Mean age at operation was 4.6 years (11 months - 16 years). Seventeen (77.3%) had stage III and 5 stage Iv stenosis. Six (22.7%) had associated clinical conditions and 3 (13.6%) associated vocal cord mobility defects. Ten (45.5%) underwent 1-stage surgery, 12 (54.5%) had a concomitant temporal tracheostomy. In 18 (81.8%) patients a primary cricotracheal resection was practiced, 4 (18.2%) required an extended one. No transoperative complications occurred. A patient with type 1 diabetes mellitus had anastomotic dehiscence on her fourth postoperative day. Seventeen (77.3%) patients developed postoperative granulation tissue that was endoscopically resected. Mean follow-up was 1.2 years (2 months - 2.8 years). No deaths occurred. Overall decannulation rate was 90.9%. Fifhteen children (88.2%) with stage III and 5 (100%) with stage IV live a normal life without tracheostomy. Conclusions: Partial cricoid resection and termino-terminal anastomosis has been a feasible procedure with reproducible successful results among our patients.