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Right arrow Trachea and bronchi

J Thorac Cardiovasc Surg 2005;130:726
© 2005 The American Association for Thoracic Surgery

General Thoracic Surgery

Partial cricotracheal resection for pediatric subglottic stenosis: Long-term outcome in 57 patients

Yves Jaquet, MD, Florian Lang, MD, Raphaelle Pilloud, MD, Marcel Savary, MD, Philippe Monnier, MD *

Department of Otolaryngology, Head and Neck Surgery, Lausanne University Medical Center (CHUV), Lausanne, Switzerland.

Received for publication February 15, 2005; revisions received April 14, 2005; accepted for publication April 22, 2005.

* Address for reprints: Philippe Monnier, MD, Department of Otolaryngology, Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland (Email: philippe.monnier{at}hospvd.ch).

OBJECTIVE: We sought to assess the long-term outcome of 57 pediatric patients who underwent partial cricotracheal resection for subglottic stenosis.

METHODS: Eighty-one pediatric partial cricotracheal resections were performed in our tertiary care institution between 1978 and 2004. Fifty-seven patients had a minimal follow-up time of 1 year and were included in this study. Evaluation was based on the last laryngotracheal endoscopy, the responses to a questionnaire, and a retrospective review of the patient's data. The following parameters were analyzed: decannulation rates, breathing, voice quality, and deglutition.

RESULTS: A single-stage partial cricotracheal resection was performed in 38 patients, and a double-stage procedure was performed in 19 patients. Sixteen patients underwent an extended partial cricotracheal resection (ie, partial cricotracheal resection combined with another open procedure). At a median follow-up time of 5.1 years, the decannulation rates after a single- or double-stage procedure were 97.4% and 95%, respectively. Two patients remained tracheotomy dependent. One patient had moderate exertional dyspnea, and all other patients had no exertional dyspnea. Voice quality was found to improve after surgical intervention for 1 ± 1.34 grade dysphonia (P < .0001) according to the adapted GRBAS grading system (Grade, Roughness, Breathiness, Asthenia, and Strain).

CONCLUSIONS: Partial cricotracheal resection provides good results for grades III and IV subglottic stenosis as primary or salvage operations. The procedure has no deleterious effects on laryngeal growth and function. The quality of voice significantly improves after surgical intervention but largely depends on the preoperative condition.






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