Reconstructive surgeries on the larynx and cervical trachea in children

Abstract

Introduction. One of the urgent problems in pediatric surgery and otorhinolaryngology is stenosis of the upper respiratory tract in children. Among many causes leading to airway narrowing , basic ones are: cicatricial stenosis, bilateral vocal cord paralysis and volumetric formations.Diagnostics. Currently, fibroscopy of the upper respiratory tract is a gold standard of this pathology examination.Methods. There are many surgical techniques to treat upper airway stenosis, but currently there is no any unified approach to the choice of surgical tactics. The given article presents an overview on modern techniques of reconstructive surgery which have demonstrated good and excellent results and a high percentage of decannulation. Among them, there are two basic ones - endoluminal surgery and open surgery. Recently, reports on the effectiveness of microsurgical interventions have been published , namely, reinnervation of the larynx to restore vocal cords. The most effective endoscopic surgeries in pediatrics are balloon dilation, bougienage and CO2- laser treatment. Patients with stenosis of stages III-IV, with extended stenosis, marked laryngomalacia, larynx and trachea deformity because of unsuccessful previous surgeries are recommended to have open reconstructive surgery. Laryngoplasty, laryngoplasty with T-tube and crico-tracheal resection are regarded as a choice option in case of ineffective previous surgeries.Conclusion. Thus, type of surgical intervention, indications and patient’s age for surgery are chosen individually for each patient with upper respiratory tract stenosis.