Diego Preciado1, Robin T Cotton, Michael J Rutter. 1. Division of Pediatric Otolaryngology/Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45215, USA.
Abstract
OBJECTIVE: While tracheal resection for management of tracheal stenosis is an effective technique that has been well described in adults, the results in children have been less encouraging, as children tolerate anastomotic tension less well than adults. We describe our current technique for the management of severe tracheal stenosis in older children. METHODS: Four teenagers, 16-17 years of age, presented with severe tracheal stenosis. A 16-year-old girl had sustained tracheal stenosis following prolonged intubation, and presented with a severe Grade III stenosis having had 25 endoscopic procedures, and a failed resection at another institute. Two 17-year-old boys and a 17-year-old girl presented with Grade IV stenosis at the suprastomal area following previous intubation injuries. All four children had an identical procedure with tracheal resection over a Hood tracheal stent. RESULTS: All four children were extubated in the operating room. Chin-to-chest sutures were removed between 7 and 10 days, as was the Hood stent. All four are currently asymptomatic with no airway stenosis. CONCLUSIONS: Although tracheal resection for tracheal stenosis in children is associated with a higher failure rate than is seen in the adult population, even severe stenosis and long segment resection may achieve excellent results. We feel that important factors influencing outcome in this series included anastomosis to an intact cricoid ring, and support of the anastomosis with a tracheal stent.
OBJECTIVE: While tracheal resection for management of tracheal stenosis is an effective technique that has been well described in adults, the results in children have been less encouraging, as children tolerate anastomotic tension less well than adults. We describe our current technique for the management of severe tracheal stenosis in older children. METHODS: Four teenagers, 16-17 years of age, presented with severe tracheal stenosis. A 16-year-old girl had sustained tracheal stenosis following prolonged intubation, and presented with a severe Grade III stenosis having had 25 endoscopic procedures, and a failed resection at another institute. Two 17-year-old boys and a 17-year-old girl presented with Grade IV stenosis at the suprastomal area following previous intubation injuries. All four children had an identical procedure with tracheal resection over a Hood tracheal stent. RESULTS: All four children were extubated in the operating room. Chin-to-chest sutures were removed between 7 and 10 days, as was the Hood stent. All four are currently asymptomatic with no airway stenosis. CONCLUSIONS: Although tracheal resection for tracheal stenosis in children is associated with a higher failure rate than is seen in the adult population, even severe stenosis and long segment resection may achieve excellent results. We feel that important factors influencing outcome in this series included anastomosis to an intact cricoid ring, and support of the anastomosis with a tracheal stent.