[Open surgical treatment of laryngo-tracheal stenoses in children].
BACKGROUND
Treatment strategy in laryngo-tracheal stenoses in children has for a long time been conservative treatment with tracheostomy or bougination in hope of a more or less spontaneous resolution of the stenosis during growth of the child. The results of this option as well as the endoscopic treatment with different laser systems has proved to be rather disappointing. A child with a tracheostomy means a heavy load for the parents to look after this child as well as a constant threat from complications by displacement or plugging of the cannula.


METHODS
A retrospective chart review of 22 children, aged between two months and 15 years at the time of surgery with laryngo-tracheal stenoses treated by different open surgical procedures.


RESULTS
The aetiology of the stenoses was prolonged endotracheal intubation in 12 children, congenital stenoses in 3 children, unsuccessful laser treatment for acquired stenoses in 3 children, subglottic hemangioma in 3 children and a transglottic cyst in 1 child. 17 cases were treated by laryngo-tracheal reconstruction with rib cartilage graft, 3 crico-tracheal resections, and 2 laryngofissures. Five children could be treated without tracheostomy. From the remaining 17 cases 13 could be decannulated, 1 child died one week after surgery from his congenital heart disease. 3 children are still with a tracheostomy, two of them had had endoscopic laser therapy alio loco before.


CONCLUSIONS
Open laryngo-tracheal surgery for paediatric airway stenoses is a successful treatment option besides endoscopic management for selected cases. Resection surgery seems to be indicated for severe stenoses with proliferative scar tissue formation. Depending on personal experience and post-operative facilities procedures without tracheostomy but prolonged post-operative intubation are possible single-stage-solutions.
Deitmer
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HNO-Klinik, Städtische Kliniken Dortmund. stkd.hno@dokom.net
D000293:Adolescent; D002356:Cartilage / Q000637:transplantation; D002648:Child; D002675:Child, Preschool; D003413:Cricoid Cartilage / Q000601:surgery; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D007829:Laryngostenosis / Q000601:surgery*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012272:Ribs; D013997:Time Factors; D014132:Trachea / Q000601:surgery; D014135:Tracheal Stenosis / Q000601:surgery*; D014140:Tracheotomy