PARTIAL CRICOTRACHEAL RESECTION FOR SEVERE PEDIATRIC SUBGLOTTIC STENOSIS - UPDATE OF THE LAUSANNE EXPERIENCE

Until recently, severe pediatric subglottic stenosis (SGS) has been tr eated almost exclusively by laryngotracheoplasty procedures. Even in t he most experienced centers, the results of single-stage operations fo r Cotton's grade III and IV stenoses have been disappointing. This pap er reports our experience on 31 partial cricotracheal resections for s evere SGS in infants and children. The stenosis was congenital in 6 ca ses and acquired after prolonged intubation in 25 cases. Twenty-seven patients were tracheotomy-dependent at the time of surgery. Twenty-two cases were classified as grade III and 9 cases as grade IV stenoses a ccording to Cotton. The decannulation rate was 97% (30 of 31 cases) af ter an open procedure. There were no fatalities and no lesions to the recurrent laryngeal nerves, but there was 1 complete restenosis. Twent y-seven patients show no exertional dyspnea, 3 have a slight strider w ith some dyspnea while exercising: and 1 patient is not decannulated. The voice is normal in 21 cases, a dysphonia is present in 9 cases, an d the patient with complete restenosis acquired an esophageal voice. P ostoperative follow-up is longer than 10 years in 8 cases and longer t han 5 years in an additional 6 cases. All patients who reached adultho od show normal growth of the larynx and trachea. Considering the excel lent results obtained in this consecutive series of 31 cases, partial cricoid resection with primary thyrotracheal anastomosis should be con sidered an important treatment option for severe SGS in infants and ch ildren.