Airway stenting with the LT-Mold: experience in 30 pediatric cases.
OBJECTIVE
The purpose of this study was to assess the safety and efficacy of stenting in upper airway reconstructions for benign laryngotracheal stenosis (LTS) with a newly designed prosthesis, the LT-Mold.


METHODS
The LT-Mold and its proper use during open surgery and endoscopy are described, and the experience gathered from a prospectively collected database on 30 pediatric patients treated for complex LTS or severe aspiration is reported. This series is compared to the results with other stenting methods.


RESULTS
From the 30 patients, 24 were available for evaluation. In six cases, the prosthesis was still in place. In no patient did the prosthesis induce any pressure necrosis or granulation tissue formation in the supraglottis and glottis. Before adding a distal round-shaped silicone cap to the LT-Mold, some granulation tissue was seen at the upper margin of the tracheostoma. One prosthesis extrusion and loss of the silicone cap in three cases have to be reported. Twenty-one of 24 patients were decannulated after a mean duration of stenting of 3 months (range 1-12 months). The mean follow-up after decannulation was 1.5 years.


CONCLUSIONS
The early experience with the LT-Mold shows that long-term stenting for complex LTS is safely achieved when the prosthesis is used with its distal cap. The softness and smoothness of the prosthesis with a round-shaped configuration of both of its extremities help avoid ulceration and granulation tissue formation in the reconstructed airway. Adequate fixation is mandatory to avoid extrusion.
Monnier
Philippe
P
Otolaryngology, Head & Neck Surgery Department, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland. philippe.monnier@chuv.ch
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods; D004867:Equipment Design; D005260:Female; D006801:Humans; D007223:Infant; D007829:Laryngostenosis / Q000453:epidemiology / Q000601:surgery*; D007831:Larynx, Artificial; D008297:Male; D010036:Otolaryngology / Q000295:instrumentation; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D053120:Respiratory Aspiration / Q000453:epidemiology; D012720:Severity of Illness Index; D015607:Stents; D014135:Tracheal Stenosis / Q000453:epidemiology / Q000601:surgery*