ENDOSCOPIC MANAGEMENT OF PEDIATRIC POSTERIOR GLOTTIC STENOSIS

Open laryngofissure with posterior cartilage grafting is advocated by some as the main treatment for posterior glottic stenosis in children. Endoscopic arytenoidectomy has been tried and recommended for bilater al vocal cord paralysis in children, but little published experience e xists in its use for the treatment of pediatric posterior glottic sten osis. We describe our experience with this technique in 11 children ag es 2 to 12 years, 6 of whom were under the age of 5 years. Nine of 11 patients at the initial surgery were tracheotomy-dependent; 2 others h ad previous laryngofissure with cartilage grafting, but continued to s uffer from severe airway limitations. Modified carbon dioxide laser ar ytenoidectomies resulted in decannulation in 5 of 9 children and marke d improvements in the 2 children without tracheotomies, as documented by flow volume loops and symptoms. Endoscopic arytenoidectomy, in our experience, is not as successful as open techniques described in previ ously published series of children, and requires multiple procedures d ue to the regrowth of granulation tissue. However, endoscopic repair i s a viable option for low-grade stenosis and does not preclude an open repair in the future. It is also useful as an adjunctive procedure to augment the repair from an open approach.