Abstract
Objective
We compare decannulation rates after Laryngotracheal Reconstruction(LTR) and Cricotracheal Resection(CTR) in matched patients. Glottic Stenosis remains a challenge and can be treated by Extended Partial Cricotracheal Resection(PCTR). The objective of the paper is to systematically classify patients to be treated by these different techniques.
Methods
In 61% of patients, single-stage PCTR with peroperative resection of the tracheostoma was chosen if no more than 5 tracheal rings were resected with the SGS. If the location of the tracheostoma requires the resection of 6 or more tracheal rings, then PCTR was performed in 2 stages. 13% of children in this group sustained an anastomotic dehiscence, compared to 4.5% of children who had a shorter tracheal resection. 17 patients who weighed under 10 kg of body weight and were less than 1 year old underwent CTR and have all been decannulated.
Results
It is noteworthy that more than a single procedure was necessary in 68% of the cases to reach the aforementioned results with LTRs, whereas only 18% of the cases needed a second open procedure to achieve decannulation with PCTR. Extended PCTR with LT mold for complex frozen larynges has proven to have promise. Complications included anastomotic granulations, minor dehiscence. No patient had a recurrent laryngeal nerve palsy.
Conclusions
LTR is a less extensive procedure and is preferred for some grade II and less severe grade III stenoses. CTR is reserved for severe grade III and IV stenosis. Stenosis close to the vocal cords remains a challenge and can be treated by extended PCTR.
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