Serial dilation compared to elective laryngo-tracheoplasty in the treatment of acquired subglottic stenosis in children.

Acquired incomplete subglottic stenosis in children has historically been managed by serial bouginage of the strictured region sometimes accompanied by injection or systemic administration of corticosteroid medications. The forceful stretching of the scar whilst awaiting growth of the region to compensate for scar contracture, however, dooms that child to a prolonged period of waiting for an unpredictable result with a tracheotomy in place. Recently, laryngo-tracheoplasty has been undertaken in younger age groups and in a review of 30 children, with very similar types of stenosis, it was noted that the 19 children managed only by bouginage (with or without steroids) (1) had a much less predictable result, (2) were only able to be ultimately decannulated 52.6% of the time, and (3) had a mean time from the initiation of treatment to decannulation of 620.1 days. This contrasted very sharply with 11 children who underwent an elective laryngo-tracheoplasty of whom 81.8% were able to be decannulated with a mean time from the initiation of treatment of 82.33 days. It was noteworthy that of those managed by dilation alone 9 children (47.4%) were tracheotomy-dependent following treatment and 7 of these were aphonic (36.8% of the total group), whereas in the surgically managed group, 2 were tracheotomy-dependent (18.2% of the total), and all could talk around their tracheotomy tube. The methods and mechanics of such therapeutic approaches are examined and discussed.