Airway salvation after failed anterior graft in a child with long segment stenosis

Objectives

1-Recognize difficulties and review techniques in long-segment laryngotracheal stenosis repair. 2-Contribute to increasing clinical and surgical skills in pediatric airway reconstruction through reporting our experience with a novel reconstruction technique involving use of a failed anterior graft and prolonged postoperative stenting.

Methods

Case report: 10 year old male with history of burn injury who required a tracheostomy due to prolonged intubation/inhalational injury in 2005. Subglottic/tracheal stenosis was identified and he subsequently underwent anterior costal cartilage grafting involving the thyroid cartilage, cricoid cartilage, and trachea. He remained tracheostomy dependent for six years due to failed graft and postoperative complications despite several attempts to improve the airway with CO2 laser and balloon dilation. In 2011, preoperative CT with 3D reconstruction revealed a 32 mm long segment of complete stenosis. The patient underwent suprahyoid release and single stage reconstruction with cricotracheal resection and partial preservation of the anterior costal cartilage graft found in the luminal scar tissue.

Results

Postoperatively the patient was stented with a nasal endotracheal tube for 2 weeks. Bronchoscopy showed mild tracheal collapse inferior to the site of anastamosis and granulation tissue at the site of anastomosis. Granulation tissue was removed and the subglottic anastomosis site was stented with a 2 cm Dumon stent for 6 months.

Conclusion

The problem of long segment stenosis after failed cartilage graft reconstruction of the airway is evaluated and a novel technique of laryngotracheal reconstruction involving a pre-existing failed anterior graft and short segment stenting is described.