Strategy for surgical treatment of congenital subglottic stenosis in children.
Congenital subglottic stenosis is a rare anomaly caused by thickened cricoid cartilage. We report our surgical techniques, comprising anterior cricoid split (ACS), laryngotracheoplasty (LTP), KTP laser ablation, and application of a tracheal opening retainer (TOR) into the tracheostomy site.
Nine patients have been treated since 1988. Four patients (median age 85 days; range 5 days to 6 months) underwent ACS. Another four patients (median age, 17 months; range, 5-57 months) underwent LTP using costal cartilage grafts, although two had undergone tracheostomy before LTP. One patient underwent LTP, ablation of the projecting part of the cricoid cartilage with KTP laser (LTP + Laser) and, preservation of the tracheal opening by placement of the TOR.
All ACS and LTP patients were successfully extubated at a median of 32 days (range 23-91 days) and 23 days (range 6-31 days) postoperatively, respectively. The LTP + Laser patient was extubated 35 days after surgery and the TOR was removed asymptomatically 20 days after extubation of the stent tube.
Anterior cricoid split is useful for patients ≤6 months old and LTP is useful for patients >6 months old and/or with tracheostomy. KTP laser ablation is effective to remove thickened parts of cricoid cartilage protecting the vocal cords. The tracheal opening preserved by the TOR works as an additional channel to safeguard respiration during the extubation process.
Department of Surgery, Kobe Children's Hospital, Kobe, 654-0081, Japan, firstname.lastname@example.org.
This article was published in the following journal.
Name: Pediatric surgery international
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22926511
- DOI: http://dx.doi.org/10.1007/s00383-012-3134-2
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Medical and Biotech [MESH] Definitions
Inflammation involving the GLOTTIS or VOCAL CORDS and the subglottic larynx. Croup is characterized by a barking cough, HOARSENESS, and persistent inspiratory STRIDOR (a high-pitched breathing sound). It occurs chiefly in infants and children.
Congenital open-angle glaucoma that results from dysgenesis of the angle structures accompanied by increased intraocular pressure and enlargement of the eye. Treatment is both medical and surgical.
A stricture of the ESOPHAGUS. Most are acquired but can be congenital.
A pathological constriction that can occur above (supravalvular stenosis), below (subvalvular stenosis), or at the AORTIC VALVE. It is characterized by restricted outflow from the LEFT VENTRICLE into the AORTA.
A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases.