Τρίτη, 30 Ιουλίου 2019


Slide laryngotracheoplasty for congenital subglottic stenosis in newborns and infants
László Rovó MD, PhD  Eszter Erdélyi MD  Zoltán Tóbiás MD  Péter Gál MD  Ilona Szegesdi MD  Balázs Sztanó MD, PhD  Kishore Sandu MD  Ádám Bach MD, PhD
First published: 27 July 2019 https://doi.org/10.1002/lary.28192
Editor's Note: This Manuscript was accepted for publication on June 27, 2019.
The authors have no funding, financial relationships, or conflicts of interest to disclose.
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Abstract
Objectives
Subglottic stenosis is the most common laryngeal anomaly necessitating tracheostomy in early childhood. Crico‐ and laryngotracheal resection and laryngotracheal reconstruction—usually with autologous cartilage graft implantation—are the most effective treatments. These surgical techniques are obviously challenging in neonatal age and infancy. However, a reconstructive surgery performed at early age may prevent the sequel of complications.

Methods
The authors present their novel surgical method for congenital subglottic stenosis. Seven infants had inspiratory stridor; two of them had to be intubated and one required tracheostomy. Laryngotracheoscopy, CT or MRI revealed subglottic stenosis: Cotton‐Myer grade II in one, and grade III in six cases. Slide laryngotracheoplasty was performed before 5 months of age (10–130 days), with a follow‐up period of average 36 months (4–80 months). Phoniatry and quality of life questionnaire were used for evaluation of postoperative results.

Results
Slide laryngotracheoplasty in the neonatal age made the temporary tracheostomy unnecessary. All babies remained intubated for 3 to 10 days with an uncuffed tracheal tube. After extubation, no dyspnea or swallowing disorder occurred. A subjective quality of life questionnaire, laryngotracheoscopy, clinical growth charts showed satisfactory functional results.

Conclusions
Single‐stage slide laryngotracheoplasty might be a favorable solution for subglottic stenosis, even in early childhood. In one step, the airway can be maintained without stenting and tracheostomy.

Level of Evidence
4

Laryngoscope, 2019

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