Analysis of Failure Causes of Open Airway Reconstruction in Children With Combined Subglottic and Posterior Glottic Stenosis
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Objectives Airway reconstruction surgery in children is still challenging,especially in cases of combined subglottic and posterior glottic stenosis (PGS). The aimof this study was to review the underlying reasons of failure in open airway reconstructionsurgeries performed for children with combined subglottic and PGS. Subjects and Method We reviewed medical records of seven children who received morethan two open airway reconstruction surgeries to finally achieve and maintain decannulationstatus for more than one year. Twenty-two reconstructive surgeries were performed and theyconsisted of 19 laryngotracheal reconstruction (LTR), 2 cricotracheal resection with end-toendanastomosis (CTR) and one extended CTR. For each patient, the following potentialcauses of failure were evaluated; preoperative evaluation (PE), type of reconstruction (TR),single vs. double staging (SDS), type of stent (TS), and perioperative optimization (PO). Results The median age of patients at the time of surgery was 32 months (range, 4-64months). Successful decannulation was achieved after the median open surgery of three (range,2-5 times for each patient). Recognized causes of failure were as follows: 8 insufficient PE,10 inadequate TR, 3 improper SDS, 8 ill-chosen TS, and 2 inappropriate PO. Conclusion PE of dynamic airway is important, especially vocal fold mobility and tracheomalacia. Types of reconstruction should be carefully decided after full consideration of potentialcauses of failure, and adequate laryngotracheal stent is essential.
Abstract
Background and Objectives Airway reconstruction surgery in children is still challenging,especially in cases of combined subglottic and posterior glottic stenosis (PGS). The aimof this study was to review the underlying reasons of failure in open airway reconstructionsurgeries performed for children with combined subglottic and PGS. Subjects and Method We reviewed medical records of seven children who received morethan two open airway reconstruction surgeries to finally achieve and maintain decannulationstatus for more than one year. Twenty-two reconstructive surgeries were performed and theyconsisted of 19 laryngotracheal reconstruction (LTR), 2 cricotracheal resection with end-toendanastomosis (CTR) and one extended CTR. For each patient, the following potentialcauses of failure were evaluated; preoperative evaluation (PE), type of reconstruction (TR),single vs. double staging (SDS), type of stent (TS), and perioperative optimization (PO). Results The median age of patients at the time of surgery was 32 months (range, 4-64months). Successful decannulation was achieved after the median open surgery of three (range,2-5 times for each patient). Recognized causes of failure were as follows: 8 insufficient PE,10 inadequate TR, 3 improper SDS, 8 ill-chosen TS, and 2 inappropriate PO. Conclusion PE of dynamic airway is important, especially vocal fold mobility and tracheomalacia. Types of reconstruction should be carefully decided after full consideration of potentialcauses of failure, and adequate laryngotracheal stent is essential.
참고문헌 (20)
- Maeda K, "Management of laryngotracheal stenosis in infants and children : The role of re-do surgery in cases of severe subglottic stenosis", Pediatr Surg Int, 29(10), pp.1001~1006 (2013)
- Chueng K, "Primary dilatation as a treatment for pediatric laryngotracheal stenosis : A systematic review", Int J Pediatr Otorhinolaryngol, 77(5), pp.623~628 (2013)
- Hartnick CJ, "Surgery for pediatric subglottic stenosis : Disease-specific outcomes", Ann Otol Rhinol Laryngol, 110(12), pp.1109~1113 (2001)
- Smith ME, "Mitomycin C and the endoscopic treatment of laryngotracheal stenosis : Are two applications better than one?", Laryngoscope, 119(2), pp.272~283 (2009)
- Gungor A, "Balloon dilation of the pediatric airway : Potential for disaster", Am J Otolaryngol, 33(1), pp.147~149 (2012)
- Edmondson NE, "Serial intralesional steroid injection combined with balloon dilation as an alternative to open repair of subglottic stenosis", Int J Pediatr Otorhinolaryngol, 74(9), pp.1078~1081 (2010)
- Mirabile L, "Endoscopic anterior cricoid split and balloon dilation in pediatric subglottic stenosis", Int J Pediatr Otorhinolaryngol, 74(12), pp.1409~1414 (2010)
- Maksoud-Filho JG, "Early diagnostic and endoscopic dilatation for the treatment of acquired upper airway stenosis after intubation in children", J Pediatr Surg, 43(7), pp.1254~1258 (2008)
- Poetker DM, "Association of airway abnormalities and risk factors in 37 subglottic stenosis patients", Otolaryngol Head Neck Surg, 135(3), pp.434~437 (2006)
- Younis RT, "Laryngotracheal reconstruction without stenting", Otolaryngol Head Neck Surg, 116(3), pp.358~362 (1997)
- Penchyna Grub J, "Extended cricotracheal resection with posterior costochondral grafting for complex pediatric subglottic stenosis", Int J Pediatr Otorhinolaryngol, 88, pp.213~216 (2016)
- Myer CM 3rd, "Proposed grading system for subglottic stenosis based on endotracheal tube sizes", Ann Otol Rhinol Laryngol, 103(4 Pt 1), pp.319~323 (1994)
- Bogdasarian RS, "Posterior glottic laryngeal stenosis", Otolaryngol Head Neck Surg(1979), 88(6), pp.765~772 (1980)
- Sittel C, "Pathologies of the larynx and trachea in childhood", GMS Curr Top Otorhinolaryngol Head Neck Surg, 13, pp.Doc09~ (2014)
- de Alarcon A, "Revision pediatric laryngotracheal reconstruction", Otolaryngol Clin North Am, 41(5), pp.959~980 (2008)
- George M, "Management of severe pediatric subglottic stenosis with glottic involvement", J Thorac Cardiovasc Surg, 139(2), pp.411~417 (2010)
- Gustafson LM, "Single-stage laryngotracheal reconstruction in children : A review of 200 cases", Otolaryngol Head Neck Surg, 123(4), pp.430~434 (2000)
- George M, "Partial cricotracheal resection in children : Potential pitfalls and avoidance of complications", Otolaryngol Head Neck Surg, 141(2), pp.225~231 (2009)
- Monnier P, "Partial cricoid resection with primary tracheal anastomosis for subglottic stenosis in infants and children", Laryngoscope, 103(11 Pt 1), pp.1273~1283 (1993)
- Rutter MJ, "Cricotracheal resection in children", Arch Otolaryngol Head Neck Surg, 127(3), pp.289~292 (2001)