Update on the use of auricular cartilage in laryngotracheal reconstruction

The pediatric otolaryngologist is often called upon to aid in the diagnosis and management of subglottic stenosis. This report contains an update of o ur experience using auricular cartilage in laryngotracheal reconstruction. A retrospective review of the medical records at St Louis Children's Hospit al identified 43 children with subglottic stenosis. Thirty-one children wer e treated by use of auricular cartilage with a success late of 84%, and an overall 94% success rate after revision surgery. Eight children in whom an anterior cricoid split initially failed were secondarily treated with auric ular cartilage with a success rate of 75%. Two children initially treated w ith costochondral cartilage underwent multiple reconstructive procedures wi th either auricular cartilage or costochondral cartilage with an overall su ccess rate of 50%. The remaining 2 children had long-segment tracheal steno sis and underwent repair with auricular cartilage with a 50% success rate. We find that auricular cartilage grafts are highly effective when used in a primary single-stage procedure in children with grade I or II stenosis. We have had limited success with auricular cartilage in patients with grade I II stenosis and are reluctant to use it in grade IV stenosis, long-segment tracheal stenosis, staged reconstruction, or revision of an auricular or co stal cartilage graft laryngotracheal reconstruction.