Thyroid ala cartilage reconstruction in neonatal subglottic stenosis as a replacement for the anterior cricoid split

Cricoid split is the procedure of choice in neonatal subglottic stenosis in many paediatric institutions. However, the post-operative care of these pa tients is a concern given the potentially lethal complications which can oc cur, in particular, self-extubation. We have been using the thyroid ala car tilage (TAC) reconstruction, a proven technique, as an alternative treatmen t for this disorder to avoid these complications. The purpose of this study was to compare the results of the TAC reconstruction for this patient popu lation with the results of the cricoid split procedure previously reviewed at our own institution. Between January 1995 and December 1999, 17 patients that underwent the TAC reconstruction for neonatal subglottic stenosis wer e retrospectively reviewed. Of the 17 patients, two patients required trach eotomy prior to discharge from hospital. Fifteen patients were discharged f rom hospital with a safe airway without tracheotomy. There were only two mi nor complications. Compared with the cricoid split study, the success rate with TAC reconstruction was higher (88 vs 83%) and the major complication r ate was lower (0 vs 9%). Factors associated with failed procedures may incl ude prematurity, low birth and surgical weight and presence of severe GER. Those that failed required much greater resources in terms of post-operativ e care and length of hospital stay. The TAC reconstruction has replaced cri coid split in treatment of neonates with subglottic stenosis at our institu tion. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.