Abstract
BackgroundLaryngotracheal stenosis is a major cause of airway obstruction in pediatric age. The correction of such abnormality still remains a challenge, both because of anatomical issues in childhood and also due to the difficulty in having properly trained professionals and adequate hospital facilities. As treatment, many different surgical techniques are offered ranging from endoscopic and less invasive procedures to open surgeries, such as laryngotracheal reconstruction and cricotracheal resection. The treatment for complex laryngotracheal stenosis is considered successful when we have decannulation or resolution of respiratory failure with release from intensive care unit. Eighteen patients who were monitored at the pediatric otorhinolaryngology service between 2016 and 2019 were diagnosed with complex stenosis, with the collection of demographic data, comorbidities, degree of initial stenosis, post-treatment aspect, and whether or not decannulation occurred.ResultsOf the eighteen cases, three had congenital stenosis, fourteen had acquired stenosis, and one had mixed stenosis. Ages ranged from 4 months old to 15 years old. Six (33.3%) underwent endoscopic dilation procedures only, six (33.3%) underwent laryngotracheoplasty, and five (27.7%) cricotracheal resections. One patient underwent a slide tracheoplasty. Seven patients (38.8%) had to undergo more than one type of procedure to improve stenosis. Out of the eighteen patients, three of them were never tracheostomized. Of the remaining fifteen patients, fourteen (93.3%) were decannulated.ConclusionsThe success rate in decannulation or the resolution of respiratory failure with discharge from the ICU, after the procedures for correcting stenosis in childhood in our service, was 94.4%.
Highlights
Laryngotracheal stenosis is a major cause of airway obstruction in pediatric age
Since the improvement of neonatal and pediatric intensive care units (ICUs), acquired subglottic stenosis has come to be considered as the most common form of Laryngotracheal stenosis (LTS), with 90% being related to endotracheal intubation [2], while congenital stenosis would be present in 5% of patients [1]
Eighteen children were selected for the study, eight females and 10 males, represented in Table 1; three of them had congenital stenosis: a complete tracheal ring and two laryngeal webs
Summary
Laryngotracheal stenosis is a major cause of airway obstruction in pediatric age The correction of such abnormality still remains a challenge, both because of anatomical issues in childhood and due to the difficulty in having properly trained professionals and adequate hospital facilities. Since the improvement of neonatal and pediatric intensive care units (ICUs), acquired subglottic stenosis has come to be considered as the most common form of LTS, with 90% being related to endotracheal intubation [2], while congenital stenosis would be present in 5% of patients [1] Correcting such abnormality remains a challenge, both due to the anatomical issue in childhood and the difficulty in forming trained staff, as well as adequate hospital facilities. Posterior glottic stenosis is differentiated by the Bogdasarian classification, divided into four types [4]
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