Primary cricotracheal resection in children: indications, technique and outcome

Objective: Treatment of subglottic stenosis has benefited greatly from deve lopment of grafting techniques such as larygontracheoplasty. Meanwhile, cri cotracheal resection of the stenotic area and a major part of the cricoid c artilage have been shown to give excellent results in adults. Patients and methods: From June 1993 to June 2000, we performed cricotracheal resection. as the primary surgical procedure, for acquired (n = 13), congenital (n = 2) or mixed (n = 1) subglottic stenosis in 16 pediatric patients comprising seven boys and nine girls. At the time of surgery, the mean weight was 16 kg and the mean age was 5 years. Degree of stenosis was classified as grade II in one case, grade III in 12, and grade IV in three. Eight patients und erwent two-stage procedures with postoperative tracheostomy. A rolled reinf orced silastic stent was placed for a mean period of 20 days and the trache ostomy tube was removed within a mean period of 44 days after stent removal . Eight patients underwent single-stage procedures. The Portex(R) endotrach eal tube was used for a mean period of 4 days. Results: All patients underw ent regular clinical and endoscopic postoperative examination. Mean follow- up was 38 months. No interference with laryngotracheal growth has been note d in any case, including the five with follow-ups longer than 5 years. Conc lusions: The indications for laryngotracheoplasty and cricotracheal resecti on in children with subglottic stenosis are still unclear. Decisions must b e made on a case-by-case basis. In this article the authors discuss decisio nal factors in terms of clinical findings, surgical techniques, potential c omplications. and outcome. (C) 2001 Elsevier Science Ireland Ltd. All right s reserved.