IDEAL TIMING OF PEDIATRIC LARYNGOTRACHEAL RECONSTRUCTION

Objective: To determine whether there is an ideal age at which to perf orm a laryngotracheal reconstruction (LTR) in the pediatric population . Design: Prospective observational study. Setting: Tertiary care chil dren's hospital. Patients: Forty-eight patients aged 48 months or youn ger with laryngotracheal stenosis who underwent 50 LTRs from October 1 , 1986, to June 30, 1995. Patients were divided into 2 groups: group 1 , aged 8 through 24 months (22 patients); group 2, aged 25 through 48 months (26 patients). Intervention: Endoscopy and LTR. Main Outcome Me asures: Successful decannulation. Results: Statistical analysis showed that (I) patients in group 2 had more severe degree of laryngotrachea l stenosis as determined by duration of stenting with no difference in multiple sites of stenosis or type of repair required to correct lary ngotracheal stenosis and (2) patients in group 2 were more likely to h ave successful decannulation. Conclusion: Laryngotracheal reconstructi on at a younger age (<25 months) is important for a child's speech and language development as well as for eliminating the morbidity and mor tality associated with a tracheotomy. However, LTR at a younger age is associated with a higher risk of failure despite lesser degree of pat hology. Therefore, although we still recommend LTR at a younger age si nce it may be beneficial for a child's speech and language development and avoidance of tracheotomy complications, this recommendation may b e at the price of LTR failure and requirement far revision procedures.