© Borgis - New Medicine 3/2006, s. 58-59
Lidia Zawadzka-Głos, Mieczysław Chmielik
Laryngotracheal reconstruction using a costal cartilage graft
Department of Paediatric Otorhinolaryngology, Medical University, Warsaw, Poland
Head of Department: Prof. Mieczysław Chmielik MD, PhD
The management of paediatric laryngotracheal stenosis is a difficult problem and often involves multiple surgical procedures. Many surgical procedures, including laryngotracheal expansion with or without grafting, have been suggested for repairing laryngotracheal stenosis in children. The authors describe laryngotracheal reconstruction using a costal cartilage graft in an 8-year-old girl with severe subglottic and tracheal stenosis.
Acquired laryngotracheal stenosis is a serious long-term complication of tracheal intubation with an incidence of 0.7 to 8% in intubated children. Increased awareness and better treatment of intubated neonates helped to decrease the incidence of subglottic stenosis .
Many surgical procedures, including laryngotracheal expansion with or without grafting, have been suggested for repairing laryngotracheal stenosis in children. They can be divided into two groups: first, laryngotracheal reconstruction (LTR) procedures in which the cricoid cartilage is split and the framework is expanded with various combinations of cartilage grafts and stents; and second, cricotracheal resection (CTR), where a segmental excision of the stenotic segment is done and an end-to-end anastomosis is performed [1, 4].
Surgical reconstruction is recommended when conservative efforts to establish an adequate airway have failed. Cotton grade III (>90%), and grade IV (100%) lesions require external methods. Grade II (70% to 90%) may be amenable to either method .
Treatment must be individualized according to the pathological findings, age and general condition of the patient. Treatment in adults may differ from that in children, and some operations that are useful in children are not applicable to adults. All cases of moderate or severe laryngeal stenosis will require a tracheotomy. Once the airway is secured, endoscopic or external treatment modalities can be considered. In general, the less severe cases respond to endoscopic methods, and the more severe cases require external reconstruction.
Before surgery is done, vocal cord paralysis must be ruled out. Surgery is contraindicated if the patient has an underlying condition which necessities the patient to be tracheotomy-dependent despite adequate patency of the airway (for example a chronic pulmonary disease or neurological disease) [4, 5].
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Adres do korespondencji:
Department of Paediatric Otorhinolaryngology, Medical University in Warsaw
00-576 Warszawa, ul. Marszałkowska 24
tel./fax +48 22 628-05-84
e-mail: email@example.comNew Medicine 3/2006
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