Abstract
Objectives
1-Recognize difficulties and review techniques in long-segment laryngotracheal stenosis repair. 2-Contribute to increasing clinical and surgical skills in pediatric airway reconstruction through reporting our experience with a novel reconstruction technique involving use of a failed anterior graft and prolonged postoperative stenting.
Methods
Case report: 10 year old male with history of burn injury who required a tracheostomy due to prolonged intubation/inhalational injury in 2005. Subglottic/tracheal stenosis was identified and he subsequently underwent anterior costal cartilage grafting involving the thyroid cartilage, cricoid cartilage, and trachea. He remained tracheostomy dependent for six years due to failed graft and postoperative complications despite several attempts to improve the airway with CO2 laser and balloon dilation. In 2011, preoperative CT with 3D reconstruction revealed a 32 mm long segment of complete stenosis. The patient underwent suprahyoid release and single stage reconstruction with cricotracheal resection and partial preservation of the anterior costal cartilage graft found in the luminal scar tissue.
Results
Postoperatively the patient was stented with a nasal endotracheal tube for 2 weeks. Bronchoscopy showed mild tracheal collapse inferior to the site of anastamosis and granulation tissue at the site of anastomosis. Granulation tissue was removed and the subglottic anastomosis site was stented with a 2 cm Dumon stent for 6 months.
Conclusion
The problem of long segment stenosis after failed cartilage graft reconstruction of the airway is evaluated and a novel technique of laryngotracheal reconstruction involving a pre-existing failed anterior graft and short segment stenting is described.
1
Introduction
Ten year old male with history of burn injury required a tracheotomy due to prolonged intubation/inhalational injury at age 5. Following tracheotomy, the patient was unable to be decannulated and Otolaryngology was consulted. Subglottic/tracheal stenosis was identified involving the cricoid cartilage and the first three rings of the trachea and anterior costal cartilage grafting involving the thyroid cartilage, cricoid cartilage, and trachea was performed. The patient underwent bronchoscopy several weeks later which revealed granulation tissue and a portion of the graft was removed. One month later he underwent a repeat bronchoscopy which revealed anterior graft prolapses and an additional portion of the graft was removed. He was lost to follow-up for several months and subsequently was noted to have recurrence of the subglottic stenosis. He remained tracheotomy dependent for a total of six years due to failed graft and postoperative complications despite several attempts to improve the airway with CO2 laser and balloon dilation. In 2011, preoperative CT with 3D reconstruction revealed a 32 mm long segment of complete stenosis ( Fig. 1 ).
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