Severe acquired subglottic stenosis in children: analysis of clinical features and surgical outcomes based on the range of stenosis.
OBJECTIVE
The present study analyzed the clinical features and surgical outcomes of laryngotracheal reconstruction (LTR) in pediatric patients with severe acquired subglottic stenosis (SGS) based on the range of stenosis. The aim was to clarify the indications for LTR in severe acquired SGS.


METHODS
The medical records of 33 pediatric patients with severe acquired SGS (Myer-Cotton grade III or IV) at our institution between January 1994 and December 2013 were retrospectively reviewed.


RESULTS
Nine patients had stenosis localized at the subglottis (localized SGS), and twenty-four patients had stenosis extending to the glottis or supraglottis from the subglottis (extended SGS). 66.7 % (6/9) of localized SGS patients were intubated after infancy, and 95.8 % (22/23) of extended SGS patients were intubated in the neonatal period. The duration of intubation was significantly shorter with localized than with extended SGS. Sixteen patients underwent LTR. The operation-specific decannulation rate was 80.0 % (4/5) in the localized SGS group and 14.3 % (1/7) in the extended SGS group.


CONCLUSIONS
The range of stenosis was affected by the period and duration of endotracheal intubation. Surgical outcomes of LTR tended to differ between localized SGS and extended SGS. LTR can be effective for localized SGS.
Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan. morita_kch@hp.pref.hyogo.jp.
Keiichi
K
Morita
Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan.
Akiko
A
Yokoi
Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan.
Yuko
Y
Bitoh
Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan.
Hiroaki
H
Fukuzawa
Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan.
Yuichi
Y
Okata
Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan.
Tamaki
T
Iwade
Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan.
Kosuke
K
Endo
Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan.
Junkichi
J
Takemoto
Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan.
Akihiko
A
Tamaki
Department of Pediatric Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe, 654-0081, Japan.
Kosaku
K
Maeda
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007829:Laryngostenosis / Q000601:surgery*; D007830:Larynx / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
Acquired subglottic stenosis; Children; Laryngotracheal reconstruction; Laryngotracheal stenosis