title: Acquired total (grade 4) subglottic stenosis in children.
abstract: Pediatric acquired total subglottic stenosis (SGS) is a challenging problem. The management of these patients has evolved at our institution over the past 25 years. We conducted a retrospective study to evaluate the surgical management and outcomes of children with grade 4 SGS. Fifty-six patients have presented with acquired grade 4 SGS since 1981. The causes included previous surgery (34), prolonged intubation (15), bums (1), and unknown causes (6). Of the 56 patients, 44 (79%) were decannulated; 120 total procedures were performed, and 39 patients (70%) required more than 1 procedure for decannulation. The decannulation rate has risen from 67% in the 1980s to 86% in the 1990s. Patients who underwent cricotracheal resection (CTR) had a higher decannulation rate than patients who underwent laryngotracheal reconstruction (LTR) with anterior and posterior costal cartilage grafting (CCG) (92% versus 81%), and were less likely to need additional open procedures to achieve decannulation (18% versus 46%). The decannulation rate for children with grade 4 SGS has improved because of advances in surgical technique. Currently, the principal operations used at our institution are 1) CTR and 2) LTR with anterior and posterior CCG. There was a trend toward a higher decannulation rate in patients who underwent CTR, and they were less likely to require further reconstructive surgery before decannulation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Children's Hospital Medical Center, Cincinnati, Ohio 45267-0528, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Gustafson
authors.forename: B E
authors.initials: BE
authors.lastname: Hartley
authors.forename: R T
authors.initials: RT
authors.lastname: Cotton
mesh_terms: D000293:Adolescent; D002356:Cartilage / Q000637:transplantation; D002648:Child; D002675:Child, Preschool; D003413:Cricoid Cartilage / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007829:Laryngostenosis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D014132:Trachea / Q000601:surgery; D016896:Treatment Outcome