[Cricotracheal resection in children: indications, technique and results].
The most significant advance in the surgical treatment of laryngotracheal stenosis has been the changes in external procedures, notably in laryngotracheoplasty aimed at widening the regional stenosis with prosthetic material. In opposition with this therapeutic method, cricotracheal resection which removes the regional stenosis, and a large portion of the cricoid cartilage, has been proven to be a reliable technique in adults. Between June 1993 and June 1998, 10 children underwent cricotracheal resection. There were 5 boys and 5 girls with 9 acquired and 1 congenital stenosis (grade II =5, grade III =2, grade IV =3). At the time of the procedure, the patients' mean weight was 19 kg and mean age was 7.5 years. A tracheotomy present in 5 children prior to the procedure was left in situ postoperatively. In these children a rolled silastic sheet was used to maintain the caliber for 23 days and the tracheotomy canula was removed a mean 58 days later. In the 5 children operated on without tracheaotomy, the nasotracheal tube was removed a mean 2.5 days after the procedure. Mean follow-up was 43 months, with clinical and endoscopic surveillance. No growth retardation was observed among the 5 children presenting 4.5 years after the procedure. The choice between laryngotracheoplasty enlargement and cricotracheal resection is not based on documented evidence but on case-by-case decision making. We discuss here the points which appear to us to be the most relevant in terms of indication, surgical procedure, potential complications, and outcome.
Triglia
J
J
Service d'ORL et de Chirurgie Cervico-Faciale Pédiatrique, Hôpital d'Enfants de La Timone, Marseille. jtrglia@ap-hm.fr
Nicollas
R
R
Roman
S
S
Pech
C
C
D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007828:Laryngoscopy / Q000379:methods*; D007829:Laryngostenosis / Q000601:surgery*; D008297:Male; D014135:Tracheal Stenosis / Q000601:surgery*; D014140:Tracheotomy / Q000379:methods; D016896:Treatment Outcome
La résection crico-trachéale chez l'enfant.