Revision single-stage laryngotracheal reconstruction in children.
In this report, we discuss indications, technique, outcome, and complications of revision single-stage laryngotracheal reconstruction (SSLTR), formulate guidelines to avoid or prevent procedure failure, and establish a protocol for the management of procedure failure. We retrospectively reviewed the charts of 122 patients between the ages of 8 months and 9 years who underwent SSLTR between January 1992 and September 2001 in 2 tertiary care children's medical centers in different cities and assessed the outcomes of patients who underwent revision SSLTR. A total of 122 patients underwent SSLTR, of whom 48 patients underwent anterior and posterior grafting. Of the 122 patients, 13 had revision SSLTR; 8 of these 13 underwent the initial laryngotracheal reconstruction at another institution. Five patients had anterior grafting laryngotracheal reconstruction without stenting, 7 had anterior and posterior grafting with 1 to 21 days of endotracheal intubation, and I had cricotracheal resection and anastomosis. Of the 13 patients, 5 had anterior wall or graft collapse (grade IV stenosis), 4 had subglottic stenosis (grade IV), 2 had circumferential subglottic stenosis (grade III), and 2 had subglottic and glottic stenosis (grade IV). The overall success rate for all patients was 86% (105 of 122). The success rates for the 122 patients were as follows: anterior grafting, 100%; anterior and posterior grafting, 83% (40 of 48); and revision cases, 70% (9 of 13). We conclude that laryngotracheal reconstruction with a costal cartilage rib graft should be considered the procedure of choice for the management of subglottic stenosis. We believe that patients in whom the first procedure fails should have a high chance of success with revision SSLTR if strict guidelines and protocols are followed.
Younis
Ramzi T
RT
Department of Otolaryngology, University of Miami, Miami, Florida, USA.
Lazar
Rande H
RH
Bustillo
Andres
A
D002356:Cartilage / Q000637:transplantation; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000628:therapy; D006801:Humans; D007442:Intubation, Intratracheal; D007829:Laryngostenosis / Q000150:complications / Q000601:surgery*; D008297:Male; D019651:Plastic Surgery Procedures; D012086:Reoperation; D012189:Retrospective Studies; D014135:Tracheal Stenosis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome