Michael J Rutter1, Robin T Cotton. 1. Division of Pediatric Otolaryngology/Head & Neck Surgery, Aerodigestive and Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA. mike.rutter@cchmc.org
Abstract
OBJECTIVE: To review our experience using posterior cricoid grafts to manage pediatric patients with isolated posterior glottic stenosis (PGS). DESIGN: Retrospective review over a 12-year period. SETTING: Tertiary care pediatric hospital. PATIENTS: All patients with isolated PGS treated between 1990 and 2002, in whom PGS was the dominant airway lesion and laryngotracheoplasty was required. Patients with concomitant vocal cord paralysis, a history of posterior laryngeal clefting, a Bogdasarian type I stenosis, or subglottic stenosis worse than grade I were excluded. MAIN OUTCOME MEASURES: Cause, operative intervention, decannulation rate, failure rate, and requirement for secondary procedures. RESULTS: A total of 29 patients ranging in age from 2 to 8 years were treated (21 with a history of prolonged intubation and 8 with a history of laryngeal trauma). Twenty patients had tracheotomies in place at the time of airway reconstruction and the remainder had stridor. Costal cartilage was the preferred graft material and was used in 27 patients. Six patients were referred with a diagnosis of bilateral vocal cord paralysis, but on evaluation were found to have PGS and mobile vocal cords. In 12 patients, repair was accomplished in a single-stage procedure; a suprastomal stent was placed in 17 patients. Overall decannulation rate was 97%, though a second procedure was required in 4 patients. One patient remained tracheotomy dependent; 4 had poor voice, including 2 with a history of laryngeal fracture; and 2 had late arytenoid prolapse. CONCLUSIONS: Isolated PGS in children is effectively managed with costal cartilage grafting of the posterior cricoid. This series has seen an evolution in management, with shorter stenting periods, placement of flanged posterior grafts without sutures, and graft placement without complete laryngofissure.
OBJECTIVE: To review our experience using posterior cricoid grafts to manage pediatric patients with isolated posterior glottic stenosis (PGS). DESIGN: Retrospective review over a 12-year period. SETTING: Tertiary care pediatric hospital. PATIENTS: All patients with isolated PGS treated between 1990 and 2002, in whom PGS was the dominant airway lesion and laryngotracheoplasty was required. Patients with concomitant vocal cord paralysis, a history of posterior laryngeal clefting, a Bogdasarian type I stenosis, or subglottic stenosis worse than grade I were excluded. MAIN OUTCOME MEASURES: Cause, operative intervention, decannulation rate, failure rate, and requirement for secondary procedures. RESULTS: A total of 29 patients ranging in age from 2 to 8 years were treated (21 with a history of prolonged intubation and 8 with a history of laryngeal trauma). Twenty patients had tracheotomies in place at the time of airway reconstruction and the remainder had stridor. Costal cartilage was the preferred graft material and was used in 27 patients. Six patients were referred with a diagnosis of bilateral vocal cord paralysis, but on evaluation were found to have PGS and mobile vocal cords. In 12 patients, repair was accomplished in a single-stage procedure; a suprastomal stent was placed in 17 patients. Overall decannulation rate was 97%, though a second procedure was required in 4 patients. One patient remained tracheotomy dependent; 4 had poor voice, including 2 with a history of laryngeal fracture; and 2 had late arytenoid prolapse. CONCLUSIONS: Isolated PGS in children is effectively managed with costal cartilage grafting of the posterior cricoid. This series has seen an evolution in management, with shorter stenting periods, placement of flanged posterior grafts without sutures, and graft placement without complete laryngofissure.