Severe Glotto‐Subglottic Stenosis in Children: Surgical Treatment with Extended Cricotracheal Reconstruction Technique

Abstract

Objectives: Evaluate the efficacy of an extended variant to the CTR technique in patients diagnosed with severe glottic-subglottic stenosis (GGS), which consists of expanding the glottis stenosis by placing a costal graft over the posterior cricoid plate and then performing a tyrotracheal anastomosis. Methods: Between 2004 to 2011 at the Hospital Infantil de Mexico “Federico Gomez,” patients with severe GSS based on laryngeal endoscopic evaluation, underwent an extended double-stage CTR. They had a silastic stent for 3-4 weeks and a temporal tracheotomy, which was removed when an appropriate size of the glottis and subglottis was confirmed. Results were analyzed, basing the success of the treatment on the patient’s decannulation. Results: A total of 19 patients were identified, 8 male and 11 female, within an age range from 1 year 7 months to 13 years old, with a mean age of 6.2 years. All patients depended on tracheotomy and were sent to surgery. Fourteen had a favorable outcome and were decannulated (74%); the remaining 5 patients presented restenosis. From these 5, 1 patient has improved and is now waiting for decannulation. Only 1 patient presented anastomosis dehiscence and was successfully reoperated upon. There were no fatalities, and the 14 patients have good respiratory function. Conclusions: The combination of an extended technique to amplify the posterior glottis, where the scar is located, and the tirotracheal anastomosis, which eliminates the subglottic damage, is the only effective procedure to solve a severe glottis subglottic stenosis, as shown in our series.