Novel method for laryngotracheal reconstruction: combining single- and double-stage techniques.
OBJECTIVE
Traditional open techniques for laryngotracheal reconstruction are either single- or double-stage procedures. Some patients may benefit from the presence of a long, single-tube stent, such as an endotracheal tube, but their predicted need for a 2-stage procedure and a persistent tracheostomy is high. We describe a novel technique for airway reconstruction that combines the methods of both single- and double-stage procedures.


METHODS
We present a retrospective review of 4 patients. All patients underwent laryngotracheal reconstruction by a single surgeon. After the operation, the airway was stented with nasotracheal intubation. A small stent, fashioned from an endotracheal tube, was placed in the tracheostoma to keep it patent. The patients subsequently underwent extubation and replacement of the tracheostomy tube.


RESULTS
The study included 1 patient with grade 4 subglottic stenosis, 2 patients with grade 3 subglottic stenosis, and 1 patient with a posterior glottic scar. All were tracheostomy tube-dependent. Serial bronchoscopy was used to follow the patients for a minimum of 9 months after the operation. All 4 patients have since met the criteria for decannulation.


CONCLUSIONS
This hybrid reconstruction merges the advantages of both the single- and double-stage procedures. It adds versatility to the surgical toolbox for airway reconstruction.
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
Jennifer
J
Setlur
Stephen
S
Maturo
Christopher J
CJ
Hartnick
D000293:Adolescent; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D007829:Laryngostenosis / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D014135:Tracheal Stenosis / Q000601:surgery*; D014139:Tracheostomy / Q000295:instrumentation / Q000379:methods* / Q000639:trends; D016896:Treatment Outcome