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The management of subglottic stenosis (SGS) remains challenging. Although laryngotracheal reconstruction with a costal cartilage graft (LTR) has been widely performed, restenosis with cicatricial tissue may require long-term stenting, especially in patients with severe SGS. An anterior cricoid split (ACS) with long-term stenting has been shown to be useful for patients with mild SGS. Thus, we evaluated the clinical outcomes of patients, including severe SGS, who underwent ACS compared to those with LTR. A retrospective chart review was conducted in 25 patients with severe SGS (Grades III and IV) who underwent initial laryngoplasty (ACS or LTR) in our hospital from January 2009 to April 2018. 17 patients (8 with Grade III and 9 with Grade IV) underwent ACS, and 8 (6 with Grade III and 2 with Grade IV) underwent LTR. The median duration of stenting was 11 months (range: 0.8–50) in the ACS group and 12 months (range: 0.4–29) in the LTR group. Thirteen of 17 patients (76.5%) in the ACS group were decannulated, whereas 4 of 8 patients (50%) in the LTR group were decannulated (p = 0.2). ACS might be useful even for children with severe SGS. The optimal duration of stenting should be investigated further.

Purpose Treatment strategies and clinical outcomes of subglottic stenosis (SGS) in children are varied due to the degree and range of stenotic lesions. The optimal surgical procedure for SGS in children is still under debate. The aim of this study was to evaluate the clinical outcomes of our anterior-posterior cricoid (APC) split technique combined with long-term T-tube stenting for grade II or III SGS in children. Methods A retrospective chart review of children with SGS between January 2011 and December 2016 was conducted. APC split was performed via open procedure under rigid bronchoscopy. After splitting, a silastic T-tube was inserted as a stent and removed 6 months postoperatively. Results Seven children underwent APC split during the period. All children had undergone previous tracheostomy, and APC split was performed when the children were 3-9 years old without any intraoperative complications. Median duration of T-tube stenting was 11 months, and all children were decannulated successfully. There were T-tube-related complications, including two tube-tip granulation that required intervention and one accidental T-tube removal. Conclusion APC split is a technically simple and reproducible procedure, and it could be employed as an optimal procedure for SGS in children.

The aim of this study was to confirm laryngotracheal growth and recurrent laryngeal nerve (RLN) preservation after partial cricotracheal resection (PCTR) in a growing rabbit model by performing the procedure in pediatric animals. Six female Japanese white rabbits, 12 weeks of age, underwent PCTR. The course of the RLN was evaluated during surgery (n = 3). Endoscopic and histologic examinations were performed at 22 weeks of age (n = 6). Four non-operated rabbits, 22 weeks of age, underwent endoscopic and histologic examinations as controls. The RLN was preserved at the esophageal side and entered the larynx behind the cricothyroid joint after PCTR. Endoscopic examination showed normal vocal cord movements and the large reconstructed subglottis. Histologically, sufficient submucosal vessels and cartilage growth were identified at the reconstructed larynx. The median inside luminal area at the anastomotic site in the PCTR group was 24.8 mm2 (range 21.8–29.0 mm2), and that at the cricoid cartilage and trachea in the control group was 23.4 mm2 (range 20.0–26.6 mm2) and 25.6 mm2 (range 22.9–28.8 mm2), respectively. No interference with laryngotracheal growth was seen, and RLN preservation was confirmed after PCTR. Use of PCTR in the pediatric age group seems appropriate.

Pediatric airway surgery is a challenging field in pediatric surgery. Laryngotracheal stenosis has a variety of congenital and acquired conditions that require precise assessment and tailored treatment for each individual patient. About 90% of acquired conditions are represented by subglottic stenosis (SGS) resulting as a complication of tracheal intubation. Congenital tracheal stenosis (CTS) is a rare and life-threatening malformation, usually associated with complete tracheal rings along a variable length of the trachea. Tracheomalacia (TM) is a process characterized by flaccidity of the supporting tracheal cartilage, widening of the posterior membranous wall, and reduced anterior-posterior airway caliber. The clinical presentation can vary from almost asymptomatic patients to near fatal airway obstruction. There is considerable variation in both the morphologic subtypes and the prognosis of pediatric airway. The patients are divided into three clinical groups (mild, moderate, and severe). A further division was proposed according to the presence or absence of associated anomalies. The definitive diagnosis of pediatric airway was made by means of rigid bronchoscope and computed tomography scan with three-dimensional reconstruction (3D-CT). Rigid bronchoscopy and 3D-CT confirmed the diagnosis in all the cases. Other associated anomalies include congenital heart disease, vascular anomalies, and BPFM (maldevelopment of aerodigestive tract). After definitive diagnosis of pediatric airway lesions, surgical intervention should be considered. Surgical strategy was presented on each lesion.

Subglottic stenosis (SGS) is defined as the narrowing of the lower larynx. Difficulties in the management of subglottic stenosis, especially in the pediatric population, justify the development of experimental models. The objective of this study was to compare the two methods of experimental subglottic stenosis induction. Twenty-three dogs were randomly selected and assigned by lottery to either one of the two groups: Gp I (n = 10) of electrocoagulation; and Gp II (n = 13) of 23% NaOH injection. In Gp I, self-interruption electrocoagulation was applied to one point in each of the four quadrants of the cricoid cartilage. In Gp II, 0.2 ml of 23% NaOH was injected in the submucosal layer in the anterior and posterior portions of the cricoid cartilage. Once a week, endoscopy was performed and the caliber of the subglottic region was measured using endotracheal tubes, and the injection was repeated if there were no signs of subglottic stenosis. The animals were killed on day 21; animals that developed respiratory distress were killed before day 21. One animal in Gp I died on day14 after the injection and during transportation; two animals in Gp II died, one on day 7 due to a tracheoesophageal fistula, and the other of unknown causes on day 5. Significant subglottic stenosis (over 51% obstruction) was found in 67% of the animals in Gp I and in 64% of those in Gp II (P = 0.99). Median time to development of significant stenosis was 21 days in both groups, and required either two or three injections. Mean time for the performance of the procedures was significantly shorter (P

The last decade has seen significant advance in the surgical management of pediatric subglottic stenosis, which remains one of the most fascinating problems of the laryngotracheal complex (LTC). Refined techniques for operating on these fragile structures should reduce cricotracheal scarring to a minimum, thus avoiding a lot of severe postoperative complications in a tricky moment of laryngeal's growing up. Experimental works indicates that the LTC growth is variously affected by longitudinal anterior, posterior or lateral incisions and actually the indications for laringotracheoplasty or cricotracheal resection in children with subglottic stenosis are still unclear. Reports on fetal manipulation of cricotracheal tissues are lacking as well as early effects on airway healing, LTC growth and lung development. The aim of this study was to evaluate if the airway mucosal healing is regenerative and scarless after cricotracheal manipulation in fetuses of New Zealand White Rabbits (NZWRFs). The consequences of fetal incisions on the cricoid growth and lung development are also examined, in a group of 12 NZWRFs, manipulated at 25+/-1 days of gestational age. The does underwent halothane anesthesia and all received a bilateral longitudinal cricoidotracheotomy. Twenty sham-operated fetuses were submitted to a limited cervicotomy (control's group). At the time of retrieval (31+/-0.5 days), en bloc laryngotracheobronchial tree and lungs were collected and processed for histological and morphometric analysis. Parameters recorded included: 1) histological full-thickness examinations focusing on inflammation, foreign body reaction, fibrosis, neochondrogenesis; 2) morphometric analysis, including the fetal Subglottic Diameter (FSD), the fetal Subglottic Area (FSA), the Radial Alveolar Count (rAC) and Computer Assisted Morphometric Colorimetry (CAmc); 3)analysis of lung hypoplasia (LH) by means of lung weight/body weight (LW/BW) ratio, protein and DNA indexes; 4) finally, different fractions of lung tissue phospholipids for lung maturity assessment were studied. Student's t test, when indicated, was performed for statistical analysis (p0.05 = significant). There was no maternal mortality in this study. Ten fetuses were available for a final evaluation (16.6% mortality). In one case only, an incomplete closure of the fetal cricoidotomy was seen and could be probably due to a technical mistake. Mean fetal subglottic diameter and area were respectively 0.13+/-0.05 mm and 3.15+/-0.45 mm2 in both groups. As well as in fetal dermal repair, regeneration of the airway cartilage and mucosa were complete and scarless. LW/BW ratio, DNA content and analysis of different fractions of phospholipids were similar in experimental vs. the control group. These findings suggest that the healing processes were fibrosis-free and without evidence of scars. A complete closure of the incisions was achieved without stenosis of the fetal subglottic region. In addition, it seems that the fetal cricoidotracheotomy doesn't interfere with the laryngeal function which coordinate the amount of liquid leaving the lungs via the trachea. In addition, only a small leakage of amniotic fluid is shown and this could be responsible for normal and mature lungs.

This case report of duodenal atresia associated with a vascular ring and subglottic stenosis raises some interesting issues of management.

We report on the usefulness of spiral computed tomography (CT) with 3-dimensional (3D) reconstruction in the diagnosis of tracheobronchial abnormalities based on three cases of children with congenital tracheobronchial strictures. Images were reconstructed using a curved planar reformat and shaded surface display. The images obtained from our three cases of tracheal stenosis, subglottic stenosis and tracheobronchial strictures were extremely clear. Spiral CT with 3D reconstruction provides excellent anatomic delineation of the tracheobronchial airway, and is safe and less invasive than tracheobronchography.

A 6-year-old male presenting with features of intestinal obstruction because of a sequestrated tubular duplication of the colon is reported. The patient also had congenital subglottic stenosis, an association not yet reported with any type of gut duplication. Complete excision of the duplication was done with preservation of vascularity of the adjacent normal colon. The relevant literature is reviewed briefly.

The management of subglottic stenosis in children remains a controversial issue. This study aimed to develop a reproducible, single-stage, curative procedure for primary reconstruction of the trachea in subglottic stenosis that would be applicable in the newborn period. A method of resection of the subglottic portion of the trachea with reconstruction by primary anastomosis utilizing an anterior tracheal flap is described. Thirty young rats were operated upon according to this method, utilizing a microsurgical technique. There were 2 deaths, of which 1 was unrelated to the operation. Following surgery all the surviving rats had slight stridor due to mild postoperative oedema lasting some 3–4 days. Subsequently there were no further respiratory symptoms. The experiments were terminated 3 months following surgery when the rats had attained full adult size. Macro- and microscopical assessment of the tracheas was carried out. The study showed that in an animal model it is possible to carry out primary reconstruction of the subglottic area of a very small-calibre trachea without a diversionary tracheostomy and that the procedure is followed by good primary healing with minimal scarring, no stricturing, and no impairment of growth.