Endolaryngeal dilatation versus laryngotracheal reconstruction in the primary management of subglottic stenosis

• Published in: International journal of pediatric otorhinolaryngology 2014-08, Vol.78 (8), p.1332-1336
• Main Authors: Günaydın, Rıza Önder, Süslü, Nilda, Bajin, Münir Demir, Kuscu, Oguz, Yılmaz, Taner, Ünal, Ömer Faruk, Akyol, Umut
• Format: Article
• Language: English
• Subjects: Adolescent; Bronchoscopy; Child; Child, Preschool; Cricoid Cartilage - surgery; Cryosurgery; Dilatation; Endolaryngeal; Female; Follow-Up Studies; Humans; Laryngeal Mucosa - surgery; Laryngostenosis - classification; Laryngostenosis - therapy; Laryngotracheal reconstruction; Laryngotracheal stenosis; Laser; Laser Therapy; Male; Otolaryngology; Pediatrics; Recurrence; Retrospective Studies; Severity of Illness Index; Tracheal Stenosis - classification; Tracheal Stenosis - therapy
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/j.ijporl.2014.05.022

Abstract Objectives The scope of the study is to compare endolaryngeal dilatations (ED) with laryngotracheal reconstruction with cartilage grafting (LTRCG) in terms of restenosis. Methods Pediatric subglottic stenosis patients treated in Hacettepe University, between 2002 and 2012 were retrospectively evaluated. Patients who had ED or LTRCG as primary management were included in the study. EDs were grouped into bronchoscopic dilatation (BD), laser incision and balloon dilatation (LBD) and cold knife incision and balloon dilatation (CKBD). The groups were evaluated in terms of restenosis and decannulation rates. Results There were 35 patients (9 females, 26 males; mean age 4.42). LTRCG was performed in 16 patients (9 anterior and 7 anterior and posterior grafts). EDs were performed in 19 patients with 6 CKBDs, 7 LBDs and 6 BDs. There were 3 grade II, 13 grade III cases in the LTRCG group while 4 grade I, 6 grade II, 8 grade 3 and 1 grade 4 in the ED group. Overall decannulation rate was 97% (34/35) in all patients. Restenosis was higher in the ED group (63.2%) than the LTRCG group (31.3%) with rates of CKBD 16.7% (1/6), LBD 71.4% (5/7) and BD 100% (6/6). Restenosis rates were found to be increasing with higher grades (grade I–25%, grade II–66%, grade III–85%). Conclusion ED may need more repetitive interventions than LTRCG due to restenosis. Less restenosis might be observed when balloon is used for dilatation and cold knife for mucosal incisions.