Tracheoplasty for congenital complete tracheal rings.
OBJECTIVE
To better appreciate the complex nature of the pediatric patient with tracheal stenosis due to congenital complete tracheal rings, we evaluated clinical presentation, methods of evaluation, necessity for surgical repair, associated anomalies, and outcome.


METHODS
Retrospective study.


METHODS
Eighteen patients with long-segment tracheal stenosis due to congenital complete tracheal rings were evaluated at Cincinnati (Ohio) Children's Hospital Medical Center between 1985 and 1991. Three patients did not require surgical intervention. Fifteen patients underwent tracheoplasty with cardiopulmonary bypass through a midline sternotomy.


RESULTS
The patients with congenital complete tracheal rings usually present with respiratory compromise in the first year of life. In the majority of patients, a diagnosis was made based on the symptoms and findings of an endoscopic examination with the aid of plain film roentgenography. In selected patients, computed tomography or magnetic resonance imaging was used. We evaluated symptoms, length of stenosis, type of repair, duration of intubation, and complications, as well as the mortality associated with this procedure.


CONCLUSIONS
The technique of tracheoplasty has evolved at our institution, including the use of a posterior tracheal division, anterior castellated division, autologous pericardial patch grafting, and cricoid split with intubation for 7 to 21 days. We found the mortality associated with this procedure quite high at 47%, compared with previously published reports with mortality figures between zero and 77%.
Andrews
T M
TM
Department of Pediatric Otolaryngology, All Children's Hospital, St Petersburg, Fla.
Cotton
R T
RT
Bailey
W W
WW
Myer
C M
CM
Vester
S R
SR
D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007828:Laryngoscopy; D008279:Magnetic Resonance Imaging; D008297:Male; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D013518:Surgery, Plastic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D014057:Tomography, X-Ray Computed; D014135:Tracheal Stenosis / Q000145:classification / Q000150:complications / Q000151:congenital* / Q000175:diagnosis / Q000601:surgery*; D014140:Tracheotomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome