title: Strategy for surgical treatment of congenital subglottic stenosis in children.
abstract: OBJECTIVE
  Congenital subglottic stenosis is a rare anomaly caused by thickened cricoid cartilage. We report our surgical techniques, comprising anterior cricoid split (ACS), laryngotracheoplasty (LTP), KTP laser ablation, and application of a tracheal opening retainer (TOR) into the tracheostomy site.
  
  
  METHODS
  Nine patients have been treated since 1988. Four patients (median age 85 days; range 5 days to 6 months) underwent ACS. Another four patients (median age, 17 months; range, 5-57 months) underwent LTP using costal cartilage grafts, although two had undergone tracheostomy before LTP. One patient underwent LTP, ablation of the projecting part of the cricoid cartilage with KTP laser (LTP + Laser) and, preservation of the tracheal opening by placement of the TOR.
  
  
  RESULTS
  All ACS and LTP patients were successfully extubated at a median of 32 days (range 23-91 days) and 23 days (range 6-31 days) postoperatively, respectively. The LTP + Laser patient was extubated 35 days after surgery and the TOR was removed asymptomatically 20 days after extubation of the stent tube.
  
  
  CONCLUSIONS
  Anterior cricoid split is useful for patients ≤ 6 months old and LTP is useful for patients >6 months old and/or with tracheostomy. KTP laser ablation is effective to remove thickened parts of cricoid cartilage protecting the vocal cords. The tracheal opening preserved by the TOR works as an additional channel to safeguard respiration during the extubation process.
authors.affiliation: Department of Surgery, Kobe Children's Hospital, Kobe, 654-0081, Japan. miokamoto@hotmail.co.jp
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Okamoto
authors.forename: Eiji
authors.initials: E
authors.lastname: Nishijima
authors.forename: Akiko
authors.initials: A
authors.lastname: Yokoi
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakao
authors.forename: Yuko
authors.initials: Y
authors.lastname: Bitoh
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Arai
mesh_terms: D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007829:Laryngostenosis / Q000601:surgery*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D012189:Retrospective Studies