title: Laryngotracheal reconstruction in infants and children: are single-stage anterior and posterior grafts a reliable intervention at all pediatric hospitals?
abstract: OBJECTIVE
  To review outcomes of pediatric laryngotracheal stenosis treated by single-stage laryngotracheal reconstruction with anterior and posterior cartilage grafts and compare decannulation rate for single-stage laryngotracheal reconstruction with rates published at larger (>200 beds) pediatric tertiary care hospitals.
  
  
  METHODS
  A 4-year retrospective chart review (2004-2008) of all patients undergoing procedures coded with 2008 CPT codes 31582 (laryngoplasty for laryngeal stenosis with graft or core mold, including tracheotomy) and 31587 (laryngoplasty, cricoid split) for a pediatric, tertiary-care hospital. Interventions were single-stage laryngotracheal reconstruction with anterior and posterior cartilage grafts, and the main outcome measure was the decannulation rate after single-stage laryngotracheal reconstruction.
  
  
  RESULTS
  We identified 44 patients with subglottic stenosis, of whom 13 underwent single-stage laryngotracheal reconstruction with anterior and posterior cartilage grafts. The mean age at surgery was 2.2 years (range, 5 months to 4 years). Twelve of 13 children had Cotton-Myer grade III stenosis. Ninety-two percent (12 of 13) of children remain decannulated. The mean follow up was 52 months.
  
  
  CONCLUSIONS
  Single-stage laryngotracheal reconstruction with anterior and posterior cartilage grafts appears to be a safe and effective technique for managing patients with high-grade subglottic stenosis at intermediate size children's hospitals. Our overall decannulation rate of 92% compares favorably to that reported in the literature (84-96%).
authors: Department of Otolaryngology, Thomas Jefferson University Hospital, 111 S. 11th Street, Philadelphia, PA 19107, USA. rschmidt@nemours.org
authors: Richard J
authors: RJ
authors: Schmidt
authors: Gopi
authors: G
authors: Shah
authors: Lindsay
authors: L
authors: Sobin
authors: James S
authors: JS
authors: Reilly
mesh_terms: D002356:Cartilage / Q000637:transplantation; D002675:Child, Preschool; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007829:Laryngostenosis / Q000601:surgery*; D007830:Larynx / Q000601:surgery*; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D014132:Trachea / Q000601:surgery*; D014135:Tracheal Stenosis / Q000601:surgery*; D016896:Treatment Outcome