title: Partial cricotracheal resection for paediatric subglottic stenosis: update of the Lausanne experience with 129 cases.
abstract: OBJECTIVE
  Partial cricotracheal resection (PCTR) is widely accepted for treating severe paediatric laryngotracheal stenosis (LTS). However, it remains limited to a few experienced centres. Here we report an update of the Lausanne experience in paediatric PCTR performed or supervised by a senior surgeon (Philippe Monnier).
  
  
  METHODS
  An ongoing database of 129 paediatric patients who underwent PCTR for benign LTS between March 1978 and July 2012 at our hospital was retrospectively reviewed. Demographic characteristics and information on preoperative status, stenosis and surgery were collected. Primary outcomes were measured as overall and operation-specific decannulation rates (ODR and OSDR, respectively), and secondary outcomes as morbidity, mortality and postoperative functional results.
  
  
  RESULTS
  A total of 129 paediatric patients [79 males and 50 females; mean age, 4.1 years (1 month-16 years, median age of 2 years old)] underwent PCTR during the study period. ODR and OSDR were 90 and 81%, respectively. The decannulation rates were significantly superior for single-stage PCTR compared with double-stage PCTR in both ODR and OSDR. Eight patients died postoperatively for reasons unrelated to surgery. Partial anastomotic dehiscence was seen in 13 patients, 9 of whom were successfully treated by revision surgery. Respiratory, voice and swallowing functions were near normal or only minimally impaired in 86, 65 and 81% of patients, respectively.
  
  
  CONCLUSIONS
  PCTR is effective and feasible with good ODR and OSDR for highgrade / severe LTS. Glottic involvement and the presence of comorbidities were negative predictive factors of decannulation. Early detection and reintervention of postoperative incipient dehiscence contribute to avoiding the progress to late restenosis; however, voice improvement remains a challenge.
authors.affiliation: Service of Otorhinolaryngology, Head and Neck Surgery, Lausanne University Medical Center (CHUV), Lausanne, Switzerland granada@d3.dion.ne.jp.
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Service of Otorhinolaryngology, Head and Neck Surgery, Lausanne University Medical Center (CHUV), Lausanne, Switzerland.
authors.forename: Yves
authors.initials: Y
authors.lastname: Jaquet
authors.affiliation: Service of Otorhinolaryngology, Head and Neck Surgery, Lausanne University Medical Center (CHUV), Lausanne, Switzerland.
authors.forename: Christos
authors.initials: C
authors.lastname: Ikonomidis
authors.affiliation: Service of Otorhinolaryngology, Head and Neck Surgery, Lausanne University Medical Center (CHUV), Lausanne, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Monnier
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003413:Cricoid Cartilage / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007829:Laryngostenosis / Q000601:surgery*; D008297:Male; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D013557:Switzerland; D013997:Time Factors; D014132:Trachea / Q000601:surgery*; D014135:Tracheal Stenosis / Q000601:surgery*; D016896:Treatment Outcome
keywords: Laryngotracheal stenosis; Paediatric; Partial cricotracheal resection; Subglottic stenosis