Single-or-two-stage laryngotracheal reconstruction; comparison of outcomes

• Published in: International journal of pediatric otorhinolaryngology 1999-10, Vol.50 (1), p.51-54
• Main Authors: Saunders, M.W., Thirlwall, A., Jacob, A., Albert, D.M.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Child; Child, Preschool; Female; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Infant; Laryngostenosis; Laryngostenosis - surgery; Larynx - surgery; Male; Medical sciences; Non tumoral diseases; Otorhinolaryngologic Surgical Procedures - methods; Otorhinolaryngology. Stomatology; Reconstructive Surgical Procedures - methods; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract; Trachea - surgery; Tracheal stenosis; Tracheal Stenosis - surgery; Tracheostomy; Treatment Outcome; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/S0165-5876(99)00235-9

To compare single-stage laryngotracheal reconstruction (SSLTR) and reconstruction with tracheostomy and indwelling stent (two-stage LTR), a retrospective review was made of 69 patients undergoing laryngotracheal reconstruction for subglottic stenosis at Great Ormond Street Hospital for Sick Children. Pre-operative details recorded included grade and aetiology of subglottic stenosis, history of previous laryngeal surgery, sex of patient and age at reconstruction. As a measure of outcome, the total number of procedures including all endoscopy and further reconstruction was recorded as well as de-cannulation rate, and the need for more than one reconstruction. The patients undergoing two-stage reconstruction tended to have more severe stenosis (mean grade=2.56) compared to the SSLTR group (mean grade=2.14) and were more likely to have had previous laryngeal surgery. Inevitably, the outcome after reconstruction in the two-stage patients is therefore less favourable, and direct comparison of the two groups is not statistically valid. However, multiple regression analysis reveals that single-stage reconstruction does confer a significant independent advantage over the two-stage procedure in terms of average number of post reconstruction procedures ( p=0.006), and a significant advantage in de-cannulation rate ( p=0.03). No difference was noted in the requirement for further reconstruction between the two groups. Although a two-stage procedure is still required in certain cases such as those with very severe stenosis or respiratory insufficiency, the single-stage reconstruction is the procedure of choice for uncomplicated paediatric subglottic stenosis.