Paediatric airway stenosis: laryngotracheal reconstruction or cricotracheal resection?

Modern surgical management of paediatric laryngotracheal stenosis includes a wide variety of surgical procedures. These can broadly be divided into tw o groups. First, laryngotracheal reconstruction (LTR) procedures in which t he cricoid cartilage is split and the framework is expanded with various co mbinations of cartilage grafts and stents; and second, cricotracheal resect ion (CTR) where a segmental excision of the stenotic segment is done and an end-to-end anastomosis is performed. In this article we review the literat ure and our experience and discuss the relative indications for CTR and LTR in children. High decannulation rates have been reported for CTR; however, it remains a more extensive procedure than LTR involving extensive trachea l mobilization. If the tracheostomy site is included in the resection then a significant length of trachea is excised. Alternatively, LTR with cartila ge grafting can precisely correct a specific stenosis with minimum morbidit y and high decannulation rates for grade 2 and selected grade 3 stenosis. F or the more severe stenosis treatment with LTR has been less successful. Re trospective data from this institution suggests that the children with grad e 4 stenosis treated with LTR are more likely to require a subsequent open procedure to achieve decannulation than those treated with CTR. LTR is a le ss extensive procedure and is preferred for grade 2, selected grade 3 steno sis. CTR is the preferred option for grade 4 and severe grade 3 stenosis wi th a clear margin between the stenosis and the vocal cords.