title: Summarized institutional experience of paediatric airway surgery†.
abstract: OBJECTIVE
  The management of paediatric airway stenosis is complex, and requires a dedicated team, consisting of thoracic surgeons, phoniatricians, logopaedics, paediatricians and anaesthetists. The majority of paediatric laryngotracheal stenosis is a sequela of prematurity and prolonged post-partal intubation/tracheostomy. Surgical correction is often difficult due to a frequent combination of glottic and subglottic defects.
  
  
  METHODS
  In 2012, the Laryngotracheal Program Vienna was launched. Since then, 18 paediatric patients were surgically treated for (laryngo-)tracheal problems.
  
  
  RESULTS
  The median age of our patients was 26 months (range 2-180 months). Laryngotracheal stenosis extending up to the level of the vocal cords was evident in 9 patients. Three children were diagnosed with an isolated subglottic, and four with a short-segment tracheal stenosis or malacia. Two patients had a long-segment congenital malformation together with vascular ring anomalies. Five children were pretreated by rigid endoscopy before surgical correction, 12 of our 18 patients had a tracheostomy, 3 children were intubated at the time of operation. Different techniques of corrections were applied: laryngotracheal reconstruction (n = 4), extended partial cricotracheal resection (n = 4), cricotracheal resection with or without anterior split or dorsal mucosal flap (n = 4), slide tracheoplasty (n = 2), tracheal resection (n = 4). In 8 patients, a rib cartilage interposition was necessary in order to obtain a sufficient lumen enlargement and in 7 of these patients, an LT-Mold was placed to stabilize the reconstruction. We lost 2 patients, who were referred to our institution after failure of multiple preceding interventions, 2 and 3 months after the operation. Twelve patients are currently in an excellent condition, one is in an acceptable condition without a need for an intervention. Two patients required an endoscopic reintervention 18 and 33 months after the operation, 1 child is currently still cannulated.
  
  
  CONCLUSIONS
  Paediatric airway surgery is complex, and requires a dedicated interdisciplinary team. An armamentarium of different resection and reconstruction techniques is necessary in order to achieve good long-term results.
authors.affiliation: Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria konrad.hoetzenecker@meduniwien.ac.at.
authors.forename: Konrad
authors.initials: K
authors.lastname: Hoetzenecker
authors.affiliation: Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schweiger
authors.affiliation: Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwarz
authors.affiliation: Division of Phoniatrics-Logopedics, Medical University of Vienna, Vienna, Austria.
authors.forename: Imme
authors.initials: I
authors.lastname: Roesner
authors.affiliation: Division of Phoniatrics-Logopedics, Medical University of Vienna, Vienna, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Leonhard
authors.affiliation: Division of Phoniatrics-Logopedics, Medical University of Vienna, Vienna, Austria.
authors.forename: Doris-Maria
authors.initials: DM
authors.lastname: Denk-Linnert
authors.affiliation: Division of Phoniatrics-Logopedics, Medical University of Vienna, Vienna, Austria.
authors.forename: Berit
authors.initials: B
authors.lastname: Schneider-Stickler
authors.affiliation: Division of Phoniatrics-Logopedics, Medical University of Vienna, Vienna, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bigenzahn
authors.affiliation: Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Walter
authors.initials: W
authors.lastname: Klepetko
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007829:Laryngostenosis / Q000601:surgery*; D007830:Larynx / Q000002:abnormalities / Q000601:surgery; D008297:Male; D013517:Otorhinolaryngologic Surgical Procedures; D019651:Plastic Surgery Procedures; D014132:Trachea / Q000002:abnormalities / Q000601:surgery; D014135:Tracheal Stenosis / Q000601:surgery*; D016896:Treatment Outcome
keywords: Airway; Laryngotracheal; Peadiatric; Stenosis; Sub-glottic; Tracheal