Use of cartilage grafts in the treatment of laryngotracheal stenoses and defects in children

Stenosis of the laryngotracheal section is in most cases a sequel of intens ive care treatment. Most of the children presenting with such stenoses need tracheostomy that in consequence impedes their physical, social and langua ge development. Surgical treatment of stenosis and closure of tracheostomy as early as possible should be strived for. Reconstructive techniques using autogenous cartilage grafts have proved very effective. The aim of our stu dy was to examine the influence of different methods on the structure and f unction of reconstructed airways. In 23 children between 2 and 16 years suf fering from laryngotracheal stenosis we reconstructed the stenotic segments by insertion of autogenous cartilage grafts. Enlargement was achieved by c artilage implantation as a stent into the split cricoid plate in 16 childre n; in 3 cases we performed enlargement of the anterior wall and in 5 cases instable lateral walls of the trachea had to be reinforced. One child had t o be treated with all three techniques at once. In another case the overstr etched and soft posterior tracheal wall had to be stabilized. Enlargement o f the cricoid plate has proved excellent in cases of a high degree of steno sis of the posterior commissure (Type III and IV of the Cotton classificati on). Subglottic stenoses Type II can be treated with anterior insertion of cartilage. The use of cartilage in surgical treatment of laryngotracheal st enosis in childhood leads to safe and sufficiently satisfactory results tha t do not hamper further development of either larynx or trachea.