Thyroid alar cartilage (TAC) laryngotracheal reconstruction for severe pediatric subglottic stenosis

Abstract

PURPOSE: Laryngotracheoplasty has become an accepted treatrnent alternative for subglottic stenosis. However, the best autogenous material for laryngotracheoplasty remains controversial. Autogenous superior thyroid alar cartilage (TAC) has been successfully used in single stage Iaryngotracheal reconstruction in children with subglottic stenosis. METHODS: This is a retrospective study of 6 children (mean age 16.6 months) undergoing TAC graft laryngotracheoplasty between September, 1995, and June, 1999. Two children had immediate tracheal intubation for congenital subglottic stenosis. Four others had previous tracheostomy: 3 for severe postintubation subglottic stenosis and 1 for congenital subglottic stenosis. After an anterior cricoid split, a piece of TAC was sutured between the cut ends of the cricoid, with the graft perichondrium facing intraluminally. Endotracheal intubation was maintained postoperatively. RESULTS: Four children were successfully extubated 9 to 21 days (mean 15.5 days) postoperatively. Two required tracheostomy, which was maintained due to severe laryngomalacia and laryngotracheobronchomalacia. One child was treated with COz laser due to symptomatic recurrence of the subglottic stenosis 3 weeks after the surgery; another required fundoplication for gastroesophageal reflux 12 months after laryngotracheoplasty. There were no donor site complications in any of the six cases. Repeat laryngoscopy and bronchoscopy revealed a patent subglottic airway. Ali of them are without symptoms after a mean follow-up of 26 months. CONCLUSIONS: I) This preliminary experience indicates that the TAC graft technique is a viable option for laryngotracheal reconstruction; 2) the TAC graft has significant advantages, including a single operative incision and absence of donor-site morbidity.