The problem of pediatric laryngotracheal stenosis: a clinical and experimental study on the efficacy of autogenous cartilaginous grafts placed between the vertically divided halves of the posterior lamina of the cricoid cartilage

Abstract

Acquired laryngotracheal stenosis is a well-documented complication of endotracheal intubation. Severe acquired laryngotracheal stenosis in children responds to surgical reconstruction, including the use of grafts and stents. The most commonly described graft material is autogenous cartilage, placed in the anterior laryngotracheal complex. The role of autogenous cartilaginous grafts sewn between the divided lamina of the posterior cricoid cartilage is less well established. Several authors report good clinical results using autogenous cartilaginous grafts to the posterior larynx; the single reported animal study of grafts to the posterior larynx failed to show significant benefit. This study was undertaken to examine the hypothesis that there is no difference in survival of anteriorly placed or posteriorly placed cartilaginous grafts in the larynx of growing rabbits, and to report on 61 pediatric patients with laryngotracheal stenosis treated with autogenous cartilaginous grafts placed between the vertically divided posterior lamina of the cricoid cartilage. The animal study showed that posteriorly placed grafts survived with viability equal to or better than that of anteriorly placed grafts. The clinical study showed that 59 of the 61 patients were decannulated with satisfactory vocal quality, good exercise tolerance and sleep patterns, and with no mortality.