Surgery of acquired laryngotracheal stenosis in infants and children. Experience and results from 1988 to 1998. Part I: Laryngotracheal reconstruction

Subglottic laryngotracheal stenosis represents the most severe intubation i njury and is increasingly encountered in children due to long-term ventilat ion during intensive care treatment. Since more than 90% of these children have tracheostomies their physical, psychosocial and speech development can be greatly impaired. A tracheostomy in infants can also be a potentially l ife-threatening condition, making necessary resolution of the laryngotrache al stenosis and removal of the tracheostoma as soon as possible. During the past 10 years, we have treated 46 children with laryngotracheal problems, including 18 children with severe laryngotracheal stenosis. Ten children (3 with grade II stenosis and 7 with grade III stenosis) were treated by lary ngotracheal reconstruction using an anterior rib cartilage graft as describ ed by Cotton. One child with posterior glottic stenosis required a posterio r laminotomy with a second rib cartilage graft. Differing from the original method, we stabilized the enlarged endotracheal lumen postoperatively with a Montgomery t-tube. This was kept in place for 10 months on average (shor test period, 6 months;longest period, 12 months). All 10 children could be decannulated, and the tracheostoma closed. Three of the children were opera ted in other institutions and had a different technique prior to our interv ention. Two of our operations failed initially. However, both patients were treated successfully by a second intervention (which was the fourth operat ion for one of the patients). The reasons for our modification,the operativ e technique and tips for postoperative management, as well as possible pitf alls and complications, are discussed.