Therapeutic effectiveness of costal cartilage grafting into both anterior and posterior walls for laryngotracheal reconstruction in acquired subglottic stenosis

Laryngotracheal reconstruction (LTR) has been employed for the treatment of severe laryngotracheal stenosis for the past 6 years at Johns Hopkins Hospital. Thirty-one children underwent LTR with costal cartilage grafting, 24 of whom had Aboulker stents placed. Short stents were used in 22 patients. Six patients received definitive treatment in a single-stage LTR; 1 child had no stent placed. Twenty-six (84%) of the 31 patients were decannulated. It was concluded that decannulation can be obtained in selected patients with the short Aboulker stent or single-stage LTR. A new classification system for laryngotracheal stenosis, based on objective measurements and the separate analysis of posterior glottic fibrosis, was developed. The proposed classification system allows recommendations for treatment. Moreover, it can be easily reproduced and may facilitate comparison of results.

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Sutureless vs Sutured Posterior Costal Cartilage Grafting in Laryngotracheal Reconstruction in Children

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archoto.2011.209 ◽

2011 ◽

Vol 137 (12) ◽

pp. 1276 ◽

Cited By ~ 2

Author(s):

John E. McClay

Keyword(s):

Costal Cartilage ◽

Laryngotracheal Reconstruction ◽

Cartilage Grafting

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Treatment of idiopathic laryngotracheal stenosis with laryngotracheal reconstruction

The Journal of Laryngology & Otology ◽

10.1017/s0022215109990843 ◽

2009 ◽

Vol 123 (11) ◽

pp. 1233-1236 ◽

Cited By ~ 2

Author(s):

P Cui ◽

W Chen

Keyword(s):

Alternative Treatment ◽

Exercise Tolerance ◽

Respiratory Function ◽

Costal Cartilage ◽

Laryngotracheal Stenosis ◽

T Tube ◽

Laryngotracheal Reconstruction ◽

The Mean ◽

Cartilage Grafting ◽

Mean Time

AbstractObjectives:We evaluated the efficacy of laryngotracheal reconstruction with costal cartilage grafting for the treatment of idiopathic laryngotracheal stenosis.Methods:From January 2001 to December 2005, 129 patients with laryngotracheal stenosis were treated at our hospital. Of these patients, five (4 per cent) female patients whose ages ranged from 14 to 34 years were identified as having idiopathic laryngotracheal stenosis. These patients were treated with a modified laryngotracheal reconstruction with anterior costal cartilage grafting. A Montgomery T-tube remained in place for 12 to 22 months.Results:Three patients presented with grade three and two with grade two stenosis. Three patients were decannulated after one procedure, with normal respiratory function and good exercise tolerance; one patient was decannulated after two procedures. One patient failed decannulation. The mean time to decannulation was 13 months.Conclusions:Laryngotracheal reconstruction with anterior costal cartilage grafting is a safe and effective method, and provides an alternative treatment for idiopathic laryngotracheal stenosis.

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Pediatric Airway Reconstruction at Great Ormond Street: A Ten-Year Review

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949210100709 ◽

1992 ◽

Vol 101 (7) ◽

pp. 595-597 ◽

Cited By ~ 9

Author(s):

John N. G. Evans ◽

James W. Ochi ◽

C. Martin Bailey

Keyword(s):

Costal Cartilage ◽

Laryngotracheal Stenosis ◽

Pediatric Airway ◽

Airway Surgery ◽

Laryngotracheal Reconstruction ◽

Airway Reconstruction ◽

To Come ◽

Cartilage Grafting

One hundred eight consecutive patients with pediatric laryngotracheal stenosis requiring airway reconstruction over a 10-year period were reviewed. Thirty-two patients required revisional airway reconstruction in an attempt to achieve decannulation. Patients underwent from one to four revisional airway reconstructions, most often laryngotracheal reconstruction with costal cartilage grafting. In the Cotton grading scheme of preoperative stenosis, those patients requiring revisional airway surgery tended to come from the more severely affected categories. Twenty-two patients of 32 (69%) achieved decannulation with revisional airway reconstruction. Thus, revisional airway reconstruction is indicated if the first attempt fails.

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Auricular Cartilage Grafts in Laryngotracheal Reconstruction

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949310200402 ◽

1993 ◽

Vol 102 (4) ◽

pp. 247-254 ◽

Cited By ~ 38

Author(s):

Rodney P. Lusk ◽

D. Richard Kang ◽

Harlan R. Muntz

Keyword(s):

Costal Cartilage ◽

Subglottic Stenosis ◽

High Rate ◽

Cartilage Graft ◽

Auricular Cartilage ◽

Successful Management ◽

Cartilage Grafts ◽

Laryngotracheal Reconstruction ◽

Rate Of Success ◽

Costal Cartilage Graft

Introduction of the anterior cricoid split (decompression) and laryngotracheal reconstruction with costal cartilage graft has resulted in the successful management of many cases of subglottic stenosis. However, the procedure does not allow uniform extubation, and laryngotracheal reconstruction with costal cartilage may be too aggressive for neonates. We have explored the use of autogenous auricular cartilage graft in laryngotracheal reconstruction. Its high rate of success and low morbidity have enabled us to expand the indications. We report our experience in 23 patients with auricular cartilage grafts.

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Laryngotracheal Reconstruction for Subglottic Stenosis in Children

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948709600610 ◽

1987 ◽

Vol 96 (6) ◽

pp. 665-669 ◽

Cited By ~ 25

Author(s):

John Maddalozzo ◽

Lauren D. Holinger

Keyword(s):

Cricoid Cartilage ◽

Costal Cartilage ◽

Subglottic Stenosis ◽

Endoscopic Management ◽

Stent Insertion ◽

Laryngotracheal Stenosis ◽

High Likelihood ◽

Cartilage Grafts ◽

Laryngotracheal Reconstruction ◽

Tracheal Disease

The experience with laryngotracheal reconstruction in 20 children in Chicago is reviewed. Nine of the 20 children (45%) operated upon had congenital subglottic stenosis. Ten (50%) had acquired stenosis. One child was classified as having combined types. All patients underwent laryngotracheal reconstruction with autogenous costal cartilage grafts. Eight patients had both anterior and posterior costal cartilage grafts with stent insertion. One had a posterior costal cartilage graft only. Sixteen of the 20 children (80%) have been decannulated. Midtracheal or lower tracheal disease concomitant with laryngotracheal stenosis is an indication that endoscopic management of severe subglottic stenosis is likely to fail. Early laryngotracheal reconstruction is indicated for patients with a high likelihood of failure of endoscopic management and for those with severe cricoid cartilage deformities. Our results support the use of laryngotracheal reconstruction as an alternative to conservative (endoscopic) management of severe subglottic stenosis in carefully selected patients.

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Modifications of Airway Reconstruction in Children

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949810700501 ◽

1998 ◽

Vol 107 (5) ◽

pp. 365-369 ◽

Cited By ~ 15

Author(s):

Robert F. Ward ◽

Dimitry Rabkin ◽

Michael Gordon ◽

Max M. April

Keyword(s):

Costal Cartilage ◽

Endoscopic Control ◽

Postoperative Intensive Care ◽

Laryngotracheal Reconstruction ◽

Airway Reconstruction ◽

Grade Ii ◽

Cartilage Grafting ◽

Postoperative Intensive Care Unit ◽

Stenotic Area ◽

Grade Iii

We review our treatment experience of subglottic stenosis in 66 children. Sixty-one of these children required some form of airway expansion using cartilage grafts. Eight children had grade I (Cotton classification), 15 grade II, 28 grade III, and 15 grade IV stenosis. AH patients with grade I and II lesions were decannulated. Ninety-three percent of grade III patients and 67% of grade IV patients were also ultimately decannulated. Laryngotracheal reconstruction with costal cartilage grafting has become widely accepted for treatment of severe laryngotracheal stenosis. Several modifications of this technique have been employed to treat our patients. Recently, we have used a modified single-stage technique with an endotracheal tube stent, externally secured for 1 week, to avoid postoperative intensive care unit admission for sedation and/or paralysis, and its related complications. Posterior graft design and placement without sutures was also performed in 20 cases. A two-surgeon technique that involves a simultaneous endoscopic control of incision of the stenotic area was employed. These modifications will be described in detail.

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Tracheocutaneous Fistula After Pediatric Open Airway Reconstruction

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420987426 ◽

2021 ◽

pp. 000348942098742

Author(s):

Stephen R. Chorney ◽

Joanne Stow ◽

Luv R. Javia ◽

Karen B. Zur ◽

Ian N. Jacobs ◽

...

Keyword(s):

Costal Cartilage ◽

Case Series ◽

Primary Objective ◽

Multivariable Logistic Regression Analysis ◽

Pediatric Airway ◽

Surgical Closure ◽

Laryngotracheal Reconstruction ◽

Airway Reconstruction ◽

Tracheocutaneous Fistula

Objectives: Tracheocutaneous fistula (TCF) is a common occurrence after pediatric tracheostomy decannulation. However, the persistence of TCF after staged reconstruction of the pediatric airway is not well-described. The primary objective was to determine the rate of persistent TCF after successful decannulation in children with staged open airway reconstruction. Methods: A case series with chart review of children who underwent decannulation after double-stage laryngotracheal reconstruction between 2017 and 2019. Results: A total of 26 children were included. The most common open airway procedure was anterior and posterior costal cartilage grafting (84.6%, 22/26). Median age at decannulation was 3.4 years (IQR: 2.8-4.3) and occurred 7.0 months (IQR: 4.3-10.4) after airway reconstruction. TCF persisted in 84.6% (22/26) of children while 15.4% (4/26) of stomas closed spontaneously. All closures were identified by the one-month follow-up visit. There was no difference in age at tracheostomy ( P = .86), age at decannulation ( P = .97), duration of tracheostomy ( P = .43), or gestational age ( P = .23) between stomas that persisted or closed. Median diameter of stent used at reconstruction was larger in TCFs that persisted (7.0 mm vs 6.5 mm, P = .03). Tracheostomy tube diameter ( P = .02) and stent size ( P < .01) correlated with persistence of TCF on multivariable logistic regression analysis. There were 16 surgical closure procedures, which occurred at a median of 14.4 months (IQR: 11.4-15.4) after decannulation. Techniques included 56.3% (9/16) by primary closure, 18.8% (3/16) by secondary intention and 25% (4/16) by cartilage tracheoplasty. The overall success of closure was 93.8% (15/16) at latest follow-up. Conclusions: Persistent TCF occurs in 85% of children who are successfully decannulated after staged open airway reconstruction. Spontaneous closure could be identified by 1 month after decannulation and was more likely when smaller stents and tracheostomy tubes were utilized. Surgeons should counsel families on the frequency of TCF and the potential for additional procedures needed for closure.

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