Laryngotracheal Reconstruction With Cryopreserved Aortic Allograft as a Salvage Technique When Cricotracheal Resection Complications Occur in Paediatrics

The traditional approach to severe subglottic stenosis (SGS) in the pediatric age group is laryngotracheal reconstruction (LTR). This approach may be complex and multistaged, with variable and unpredictable success rates in the individual patient. Excellent results have been reported in adults who had severe SGS and underwent partial resection of the cricoid and primary thyrotracheal anastomosis. This procedure has not been widely reported in infants and children. We report our experience with this procedure in 16 pediatric patients with grade III or IV SGS. Eleven patients had multiple previous LTR operations. The preoperative evaluation, surgical techniques, postoperative care, complications, and final results are described and discussed. Fourteen patients were decannulated after the procedure, 1 patient needed a second open procedure prior to decannulation, and 1 patient with concomitant bronchopulmonary dysplasia remains cannulated, for an overall 94% decannulation rate. Fourteen patients have no limitation of respiration, and 1 patient has moderate exercise intolerance. The results of this series suggest that partial cricotracheal resection with primary anastomosis is a relatively safe and effective procedure for pediatric patients with severe SGS.

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Modified Minerva Cervical Thoracic Orthosis for Postoperative Management of Cricotracheal Resection

Ear Nose & Throat Journal ◽

10.1177/0145561319859348 ◽

2019 ◽

pp. 014556131985934

Author(s):

Timothy N. Baerg ◽

Jennifer F. Ha ◽

Megan Christ ◽

Glenn E. Green

Keyword(s):

Social Sciences ◽

Skin Irritation ◽

Anastomotic Dehiscence ◽

Postoperative Management ◽

Short Term ◽

Risks And Benefits ◽

Cricotracheal Resection ◽

Laryngotracheal Reconstruction ◽

Neck Control ◽

Analyze Data

The worst complication of cricotracheal resection (CTR) is anastomotic dehiscence, and to limit it, postoperative management at Michigan Medicine included the use of a modified Minerva cervical-thoracic orthosis (MMCTO). To date, there has been no analysis of the risks and benefits of the brace’s use following CTR. We analyze this with our retrospective study. A search with the keywords “cricotracheal resection” and “laryngotracheal reconstruction” was performed in the Electronic Medical Record Search Engine to identify patients retrospectively. The Statistical Package for Social Sciences was used for analysis; t test, χ2, and Fisher exact tests were used to analyze data. Fifteen males and 13 females with a median age of 4 years were identified, and almost 2/3 had a supra- and/or infrahyoid release performed. Postoperatively, 12 had a Grillo stitch and an MMCTO for a mean of 7 days. Most had no complications, but the most common complications were agitation due to brace discomfort and skin irritation. The worst complication was stroke. Our MMCTO’s design allowed for better head and neck control with relative comfortability, and most patients had no complications with its short-term use. Our modification may be useful adjunct in the postoperative management.

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Laryngotracheal reconstruction and cricotracheal resection in children: Recent experience at Great Ormond Street Hospital

International Journal of Pediatric Otorhinolaryngology ◽

10.1016/j.ijporl.2012.01.006 ◽

2012 ◽

Vol 76 (4) ◽

pp. 507-511 ◽

Cited By ~ 18

Author(s):

Y. Bajaj ◽

L.A. Cochrane ◽

C.G. Jephson ◽

M.E. Wyatt ◽

C.M. Bailey ◽

...

Keyword(s):

Recent Experience ◽

Street Hospital ◽

Great Ormond Street Hospital ◽

Cricotracheal Resection ◽

Laryngotracheal Reconstruction

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Pediatric Laryngotracheal Stenosis: Where Are We Heading

Otolaryngology ◽

10.1016/j.otohns.2008.05.215 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P67-P67

Author(s):

Kishore Sandu

Keyword(s):

Recurrent Laryngeal Nerve Palsy ◽

Anastomotic Dehiscence ◽

Tracheal Resection ◽

Vocal Cords ◽

Cricotracheal Resection ◽

Laryngotracheal Reconstruction ◽

Grade Ii ◽

Partial Cricotracheal Resection ◽

Grade Iii ◽

Severe Grade

Objective We compare decannulation rates after Laryngotracheal Reconstruction(LTR) and Cricotracheal Resection(CTR) in matched patients. Glottic Stenosis remains a challenge and can be treated by Extended Partial Cricotracheal Resection(PCTR). The objective of the paper is to systematically classify patients to be treated by these different techniques. Methods In 61% of patients, single-stage PCTR with peroperative resection of the tracheostoma was chosen if no more than 5 tracheal rings were resected with the SGS. If the location of the tracheostoma requires the resection of 6 or more tracheal rings, then PCTR was performed in 2 stages. 13% of children in this group sustained an anastomotic dehiscence, compared to 4.5% of children who had a shorter tracheal resection. 17 patients who weighed under 10 kg of body weight and were less than 1 year old underwent CTR and have all been decannulated. Results It is noteworthy that more than a single procedure was necessary in 68% of the cases to reach the aforementioned results with LTRs, whereas only 18% of the cases needed a second open procedure to achieve decannulation with PCTR. Extended PCTR with LT mold for complex frozen larynges has proven to have promise. Complications included anastomotic granulations, minor dehiscence. No patient had a recurrent laryngeal nerve palsy. Conclusions LTR is a less extensive procedure and is preferred for some grade II and less severe grade III stenoses. CTR is reserved for severe grade III and IV stenosis. Stenosis close to the vocal cords remains a challenge and can be treated by extended PCTR.

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Laryngotracheal resection can be performed safely without a guardian Chin stitch—a single-centre experience including 165 consecutive patients

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezab092 ◽

2021 ◽

Author(s):

Thomas Schweiger ◽

Matthias Evermann ◽

Imme Roesner ◽

Anna-Elisabeth Frick ◽

Doris-Maria Denk-Linnert ◽

...

Keyword(s):

Postoperative Outcome ◽

Neurological Complications ◽

Early Postoperative Period ◽

Tracheal Resection ◽

Anastomotic Complications ◽

Cricotracheal Resection ◽

Laryngotracheal Reconstruction ◽

Age At Surgery ◽

Single Centre Experience ◽

The Guardian

Abstract OBJECTIVES A tension-free anastomosis is crucial to minimize the risk of airway complications after laryngotracheal surgery. The ‘guardian’ chin stitch is placed to prevent hyperextension of the neck in the early postoperative period. This manoeuvre was introduced early in tracheal surgery and is now routinely performed by many airway surgeons. However, the evidence for or against is sparse. METHODS We performed a retrospective analysis of all adult patients receiving a (laryngo-)tracheal resection at our department from October 2011 to December 2019. According to our institutional standard, none of the patients received a chin stitch. Instead, a head cradle was used to obtain anteflexion of the neck during the first 3 days and patients were instructed to avoid hyperextension of the neck during the hospital stay. The postoperative outcome and the rate of anastomotic complications were analysed. RESULTS A total of 165 consecutive patients were included in this study. Median age at surgery was 53 years (18–80). Seventy-four patients received a tracheal resection, 24 a cricotracheal resection, 52 an extended cricotracheal resection including dorsal mucosectomy and 15 a single-stage laryngotracheal reconstruction. The median resection length was 25 mm (range 10–55 mm). One hundred and sixty-two out of 165 (98.2%) patients had an unremarkable postoperative course. One patient (0.6%) had partial anastomotic rupture after a traumatic reintubation, which required revision surgery and re-anastomosis. Two patients (1.2%) after previous radiation therapy (>60 Gy) developed a partial necrosis of the anastomosis, resulting in prolonged airleak and fistulation. At follow-up, bronchoscopy 3 months after surgery, 92.7% (127/137) of the patients had a proper anastomosis, 6.6% (9/137) had minor granuloma formations at the site of the anastomosis, which were all treated successfully by endoscopic removal. One patient received dilatation for restenosis (0.7%). CONCLUSIONS After sufficient mobilization of the central airways, postoperative anteflexion of the neck supported by a head cradle is sufficient to prevent excessive anastomotic tension and dehiscence. Considering the risk for severe neurological complications associated with the chin stitch, the routine use of this manoeuvre in laryngotracheal surgery should not be recommended.

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