Proposal of a new classification for optimising outcome assessment following partial cricotracheal resections in severe pediatric subglottic stenosis.
OBJECTIVE
Creation of a patent subglottic airway after partial cricotracheal resection (PCTR) may not always result in successful decannulation due to associated parameters such as co-morbidity and/or glottic involvement. We classified patients after incorporating these additional parameters into the original Myer-Cotton classification to assess whether this could better predict the outcome measures after PCTR.


METHODS
One hundred children with Myer-Cotton grade III or IV subglottic stenosis who underwent PCTR between 1978 and 2008 were identified from a prospectively collected database. The patients were classified into four groups based on the association of co-morbidity and/or glottic involvement. Delay in decannulation, revision open surgery and rates of decannulation were the outcome measures compared between the groups.


RESULTS
There were 68 children with Myer-Cotton grade III and 32 children with grade IV stenosis. Based on the new classification, there were 36 children with isolated SGS, 31 with associated co-morbidity, 19 with associated glottic involvement and 14 children with both co-morbidity and glottic involvement. A trend towards less optimal results was noticed with the association of co-morbidity and/or glottic involvement. Statistical significance was reached for maximum decannulation failure in the group with both co-morbidity and glottic involvement. Delayed decannulation significantly correlated in the group with associated glottic involvement.


CONCLUSIONS
This new classification is relatively simple and aimed at providing more accurate and uniform prognostic information to both patients and surgeons when dealing with the whole spectrum of severe SGS.
Monnier
Philippe
P
Department of Otolaryngology, Head and Neck Surgery, University Hospital (Centre Hospitalier Universitaire Vaudois), Lausanne 1011, Vaudois, Switzerland.
Ikonomidis
Christos
C
Jaquet
Yves
Y
George
Mercy
M
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003413:Cricoid Cartilage / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007829:Laryngostenosis / Q000145:classification* / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures; D011379:Prognosis; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014132:Trachea / Q000601:surgery