title: Laryngotracheal reconstruction outcomes in hypotonic children.
abstract: OBJECTIVE
  Children with poor muscle tone may demonstrate upper airway obstruction due to several mechanisms including obstructive sleep apnea, laryngopharyngeal reflux, and laryngomalacia. Though hypotonia has been shown to compromise the pediatric airway, and some authors suggest that neurologic deficits can compromise the success of laryngotracheal reconstruction (LTR), to our knowledge no studies have evaluated the effect of neurologic diagnoses or hypotonia on outcomes in LTR.
  
  
  OBJECTIVE
  To determine whether hypotonic children with subglottic stenosis have lower rates of successful decannulation after LTR compared with children without neurologic deficit.
  
  
  METHODS
  A retrospective medical chart review was conducted for 27 children aged 0 to 6 years, who underwent LTR for subglottic stenosis between December 2007 and December 2012 at a tertiary care children's hospital. Children were classified based on documented neurologic findings. Group 1 comprised those children without neurologic impairment (n = 16). Group 2 included those children with a documented neurocognitive or neuromuscular diagnosis but without evidence of hypotonia (n = 7). Group 3 comprised hypotonic children (n = 4). INTERVENTIONS Laryngotracheal reconstruction.
  
  
  METHODS
  The number of procedures performed after LTR to optimize the airway and whether the child was successfully decannulated.
  
  
  RESULTS
  All 16 of the neurologically intact patients (100%) were decannulated. Among children with a neurologic deficit, 5 of 7 (71%) were ultimately decannulated. No hypotonic children 0 of 4 were decannulated. The difference in rates of decannulation between unaffected and normotonic children with a neurologic deficit was not statistically significant (P = .08). However, the difference in outcomes between hypotonic children and neurologically intact patients was statistically significant (P < .001).
  
  
  CONCLUSIONS
  Findings from this study suggest that hypotonic children may experience poorer rates of post-LTR decannulation compared with children without neurologic deficit. Dynamic upper airway obstruction may be unappreciated in hypotonic children. Future research may be directed at the appropriate evaluation and treatment of children with poor muscle tone and subglottic stenosis.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Virbalas
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: John P
authors.initials: JP
authors.lastname: Bent
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle.
authors.forename: Hillel W
authors.initials: HW
authors.lastname: Cohen
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle.
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Parikh
mesh_terms: D000402:Airway Obstruction / Q000175:diagnosis / Q000601:surgery; D001999:Bronchoscopy / Q000379:methods; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007828:Laryngoscopy / Q000379:methods; D007829:Laryngostenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D009123:Muscle Hypotonia / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014135:Tracheal Stenosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome