title: Primary cricotracheal resection with thyrotracheal anastomosis for the treatment of severe subglottic stenosis in children and adolescents.
abstract: Severe subglottic stenosis in children is best managed by laryngotracheal reconstruction or cricotracheal resection (CTR). We describe clinical outcomes with CTR and end-to-end anastomosis in pediatric patients with severe subglottic stenosis in a tertiary-care pediatric teaching hospital in Mexico City. We prospectively followed up all consecutive patients younger than 18 years of age with a Myer-Cotton grade 3 or 4 subglottic stenosis who underwent CTR between May 1, 2000, and March 31, 2003. The frequency of each clinical outcome was calculated. Twenty-two patients (16 boys [72.7%] and 6 girls [27.3%]) were included. The mean age at operation was 4.6 years (range, 11 months to 16 years). Eighteen patients (81.8%) required primary CTR, and 4 (18.2%) required extended CTR. Seventeen (77.3%) had grade 3 stenosis, and 5 (22.7%) had grade 4 stenosis. Six (27.3%) had associated clinical conditions, and 3 (13.6%) had associated vocal cord mobility defects. All were tracheostomy-dependent at presentation, and none had undergone previous airway surgery. Ten (45.5%) underwent one-stage surgery, and 12 (54.5%) had a concomitant temporary tracheotomy. No intraoperative complications occurred. Seventeen patients (77.3%) developed postoperative granulation tissue requiring endoscopic resection. The mean follow-up was 1.2 years (range, 2 months to 2.8 years). No deaths occurred. Fifteen children (88.2%) with grade 3 stenosis and 5 (100%) with grade 4 stenosis were decannulated, for an overall decannulation rate of 90.9%. Partial cricoid resection with end-to-end anastomosis has been a feasible procedure with reproducible successful results among our patients. We conclude that CTR performed as a primary procedure is an effective treatment for the management of severe subglottic stenosis in children.
authors.affiliation: Department of Otorhinolaryngology, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico.
authors.forename: Hiram
authors.initials: H
authors.lastname: Alvarez-Neri
authors.forename: Jaime
authors.initials: J
authors.lastname: Penchyna-Grub
authors.forename: Juan D
authors.initials: JD
authors.lastname: Porras-Hernandez
authors.forename: Gerardo
authors.initials: G
authors.lastname: Blanco-Rodriguez
authors.forename: Ruth
authors.initials: R
authors.lastname: Gonzalez
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rutter
mesh_terms: D000293:Adolescent; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D003413:Cricoid Cartilage / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007829:Laryngostenosis / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D013957:Thyroid Cartilage / Q000601:surgery*; D014132:Trachea / Q000601:surgery*; D014140:Tracheotomy; D016896:Treatment Outcome