title: Comparison of hybrid laryngotracheal reconstruction to traditional single- and double-stage laryngotracheal reconstruction.
abstract: OBJECTIVE
  (1) To describe outcomes from and modifications to the hybrid laryngotracheal reconstruction (LTR) technique and (2) to compare this technique to traditional single- and double-stage LTR (ssLTR/dsLTR).
  
  
  METHODS
  Chart review with case series.
  
  
  METHODS
  Tertiary care otolaryngology specialty hospital.
  
  
  METHODS
  All patients under 18 years of age who underwent LTR by a single surgeon from July 1, 2009, to December 31, 2013.
  
  
  METHODS
  Charts were assessed for age, gender, etiology of stenosis, type of reconstruction, comorbidities, length of stay, complications, and tracheostomy status. Analysis was performed using Kruskal-Wallis and Wilcoxon rank sum analysis.
  
  
  RESULTS
  Forty-four patients were identified, with 13 hybrid LTRs, 27 ssLTRs, and 4 dsLTRs. Of the hybrid LTRs, an overall decannulation rate of 76.9% was noted, comparable to those for dsLTR. The hybrid LTR technique offered a significantly shorter period of narcotic use when compared to ssLTR (median 15 vs 21 days, P<.01). No patients in the hybrid LTR group developed supraglottic granulation tissue. There was no statistically significant difference in median length of stay for ssLTRs, dsLTRs, and hybrid LTRs (P=.38).
  
  
  CONCLUSIONS
  The hybrid LTR technique is well tolerated and useful in patients of all ages. Narcotics can be weaned more quickly due to the presence of a secure airway at all times via the existing tracheostomy. Use of a long stent prevents formation of granulation tissue that may be seen with a suprastomal stent. This technique should be considered in patients with high-grade stenosis with a preexisting tracheostomy.
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Nikhila
authors.initials: N
authors.lastname: Raol
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Rogers
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Setlur
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA Christopher_hartnick@meei.harvard.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hartnick
mesh_terms: D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D058753:Laryngoplasty / Q000379:methods*; D007829:Laryngostenosis / Q000601:surgery*; D007830:Larynx / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D014132:Trachea / Q000601:surgery*; D014135:Tracheal Stenosis / Q000601:surgery*; D014139:Tracheostomy / Q000379:methods*; D016896:Treatment Outcome
keywords: LTR; hybrid LTR; laryngotracheal reconstruction; subglottic stenosis