Thyroid alar cartilage laryngotracheal reconstruction for severe pediatricsubglottic stenosis

Background/Purpose: Laryngotracheoplasty has become an accepted treatment a lternative for subglottic stenosis. However, the best autogenous material f or laryngotracheoplasty remains controversial. Autogenous superior thyroid alar cartilage (TAC) has been used successfully in single stage laryngotrac heal reconstruction in children with subglottic stenosis. Methods: This is a retrospective study of 6 children (mean age, 16.6 months ) undergoing TAC graft laryngotracheoplasty between September 1995, and Jun e 1999. Two children had immediate tracheal intubation for congenital subgl ottic stenosis. Four others had previous tracheostomy: 3 for severe postint ubation subglottic stenosis and 1 for congenital subglottic stenosis. After an anterior cricoid split, a piece of TAC was sutured between the cut ends of the cricoid, with the graft perichondrium facing intraluminally. Endotr acheal intubation was maintained postoperatively. Results: Four children underwent successfully extubation 9 to 21 days (mean , 15.5 days) postoperatively. Two required tracheostomy, which was maintain ed because of severe laryngomalacia and laryngotracheobronchomalacia. One c hild was treated with CO2 laser because of symptomatic recurrence of the su bglottic stenosis 3 weeks after the surgery; another required fundoplicatio n for gastroesophageal reflux 12 months after laryngotracheoplasty. There w ere no donor site complications in any of the 6 cases. Repeat laryngoscopy and bronchoscopy showed a patent subglottic airway. All of them are without symptoms after a mean follow-up of 26 months. Conclusions: (1) This preliminary experience indicates that the TAC graft t echnique is a viable option for laryngotracheal reconstruction; (2) the TAC graft has significant advantages, including a single operative incision an d absence of donor-site morbidity. J Pediatr Surg 36:1258-1261. Copyright ( C) 2001 by W.B. Saunders Company.