title: Extended cricotracheal resection with posterior costochondral grafting for complex pediatric subglottic stenosis.
abstract: OBJECTIVE
  Severe laryngotracheal stenosis in childhood poses a complex surgical challenge for specialists in airway surgery. Patients with severe subglottic stenosis with vocal cord involvement are particularly difficult to manage successfully. The goal of this work was to review our experience with extended CTR in a cohort of young children with severe SGS and determine which clinical parameters would be associated with surgical success.
  
  
  METHODS
  Retrospective analysis of the outcome of consecutive patients with severe glottic-subglottic stenosis submitted to an extended double-stage CTR between 2004 and 2014 at a large tertiary referral center.
  
  
  RESULTS
  Twenty-five patients met inclusion criteria, with a mean age of 58.7 months at the time of repair. Overall decannulation rate was 80% (20/25), with a median time to deannulation of 120 days. Seven patients developed post-operative sequelae (4 arytenoid dislocations, 2 re-stenosis, and 1 anterior commissure adhesion). Patients with these sequelae had lower overall specific decannulation (42.8%) compared to those without any sequelae (94.4%) (Chi-square, p = 0.0123) with a longer time to decannulate (logrank, p = 0.0004). Notably, patients presenting with these sequelae on average had undergone a longer duration of post-operative stenting (27.14 days) compared to those presenting without any sequelae (14.8 days) (p = 0.0282).
  
  
  CONCLUSIONS
  Extended CTR is an effective method for resolving a majority of severe glottic-subglottic stenosis cases in children. Duration of post-operative stenting may adversely impact overall outcome in these patients.
authors: Department of Thoracic Surgery and Endoscopy, Hospital Infantil de México, Federico Gómez, Mexico.
authors: Jaime
authors: J
authors: Penchyna Grub
authors: Department of Otorhinolaryngology, Hospital Infantil de México, Federico Gómez, Mexico.
authors: Enrique
authors: E
authors: Ortíz Hernández
authors: Department of Thoracic Surgery and Endoscopy, Hospital Infantil de México, Federico Gómez, Mexico.
authors: Gustavo
authors: G
authors: Teyssier Morales
authors: Department of Thoracic Surgery and Endoscopy, Hospital Infantil de México, Federico Gómez, Mexico.
authors: Ivan
authors: I
authors: Rivas Rivera
authors: Division of Pediatric Otolaryngology, Children's National Health System, Washington, DC, USA. Electronic address: dpreciad@cnmc.org.
authors: Diego
authors: D
authors: Preciado
authors: Department of Otorhinolaryngology, Hospital Infantil de México, Federico Gómez, Mexico.
authors: Hiram
authors: H
authors: Álvarez-Neri
mesh_terms: D002648:Child; D002675:Child, Preschool; D003413:Cricoid Cartilage / Q000601:surgery*; D005260:Female; D005931:Glottis / Q000601:surgery; D006801:Humans; D007223:Infant; D007829:Laryngostenosis / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014827:Vocal Cords / Q000601:surgery
keywords: Extended cricotracheal resection; Pediatric airway; Pediatric subglottic stenosis