Surgery of acquired laryngotracheal stenosis in infants and children. Experiences and results from 1988 to 1998. Part II: Cricotracheal resection

Approximately 90% of infants and children with severe acquired laryngotrach eal stenoses are tracheotomy dependent and therefore impaired in their phys ical and speech developments. In addition, tracheotomized infants can be en dangered by the cannula due to the possible crusting of secretions or its d islocation. Thus, early repair of a stenosis is mandatory. Within the last 10 years, we successfully operated on 18 children with severe laryngotrache al stenoses. Ten children were treated with a modified Cotton technique. Th is paper reports our results of cricotracheal resection performed in 8 chil dren since 1994 (age distribution: 7 months through age 15 years). Four chi ldren had Cotton grade II stenoses, th ree had grade III stenoses and one g rade IV stenoses. In 3 patients a tracheotomy had been performed at another institution. Since their tracheostomas were too far caudal, they could not be included in the primary resection. All 8 children have been successfull y decannulated. Five children without tracheotomies could be extubated unev entfully on the 5th postoperative day. All three primarily tracheotomized c hildren needed further endotracheal stenting with T-tubes because of stomal and suprastomal collapse. Two of these latter children additionally requir ed a tracheoplasty with rib cartilage grafts in order to stabilize the supr astomal trachea prior to decannulation. No patient experienced injuries to the recurrent laryngeal nerves or insufficiencies of the anastomosis. All c hildren's voices were not impaired. This is the third report in literature of cricotracheal resections in infants and children, indicating that this e ffective, one-stage procedure is superior to laryngotracheal reconstruction with rib cartilage.