Endoscopic posterior cricoid split and rib grafting in 10 children.
OBJECTIVE
To report our experience with endoscopic posterior cricoid split and rib graft insertion (EPCS/RG) in children with posterior glottic (PGS) and subglottic stenosis (SGS).


METHODS
Retrospective analysis of case series, with 1 to 2 year follow-up.


METHODS
Tertiary-care pediatric referral center.


METHODS
Ten consecutive patients undergoing EPCS/RG.


METHODS
EPCS/RG is a new procedure that expands the posterior glottic opening by dividing the posterior cricoid lamina endoscopically with a laser and inserting a rib cartilage graft through the laryngoscope.


METHODS
Laryngeal function and hospital stay.


RESULTS
Successful decannulation in two of two patients with PGS and one of five patients with PGS and SGS without further surgery. Of the four not initially decannulated, two were decannulated with adjunctive procedures, and the other two can now tolerate tracheostomy capping for extended periods of time. We achieved improvement in exercise tolerance in three nontracheotomy-dependent patients. For those with established tracheotomies, median hospital stay was 3 days and intensive care unit care was unnecessary. There were no major complications or deterioration of voice or feeding.


CONCLUSIONS
EPCS/RG appears to be safe and effective in the management of PGS in selected pediatric patients. This minimally invasive procedure has advantages over traditional open approaches and destructive endoscopic techniques (cordotomy and arytenoidectomy). The role of EPCS/RG alone in the face of severe grades of SGS appears to be limited.
Inglis
Andrew F
AF
Department of Otolaryngology/Head and Neck Surgery, University of Washington, Children's Hospital and Regional Medical Center, Seattle 98105, USA. andy.i@seattlechildrens.org
Perkins
Jonathan A
JA
Manning
Scott C
SC
Mouzakes
Jason
J
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003413:Cricoid Cartilage / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007828:Laryngoscopy / Q000379:methods*; D007829:Laryngostenosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D012272:Ribs / Q000637:transplantation*; D012720:Severity of Illness Index; D014826:Vocal Cord Paralysis / Q000209:etiology