Pediatric laryngotracheal stenosis

Abstract

Severe laryngotracheal stenosis (LTS) in children is a problem of increasing incidence in the past 15 years, following the widespread adoption of prolonged endotracheal intubation for respiratory support. Rarer cases of stenosis secondary to external trauma, high tracheotomy, thermal and chemical burns, and dystrophic cartilage are seen. In contrast to congenital subglottic stenosis, where conservative therapy is generally indicated, severe, mature LTS often requires surgical correction--either endoscopic or external reconstruction. The prevailing attitude has been to perform a tracheotomy and hope for decannulation after 1 or 2 years, due to the expected growth of the larynx. This attitude developed from experience with congenital subglottic stenosis. Unfortunately, acquired LTS tends to be a much more severe problem than congenital subglottic stenosis; the degree of obstruction is usually greater and loss of cartilaginous support of the airway commonly occurs. Some of the acquired lesions are so severe that often no lumen is demonstrable. In such cases no amount of growth will allow extubation. A variety of endoscopic methods such as dilation, with or without resection using diathermy, cryotherapy, or laser, or steroid injection are certainly helpful in the early phases of wound healing while granulation tissue is still present or while the scar tissue is still soft and pliable. To deal with the mature, hard, fibrous unresponsive scar, various authors have proposed different approaches both endoscopic and external reconstruction. The present study discusses a unique experience of external laryngotracheal reconstruction (LTR) in 100 children. In the evaluation of LTS, a thorough endoscopic evaluation is required using both flexible and rigid endoscopic techniques.(ABSTRACT TRUNCATED AT 250 WORDS)