Successful Reconstruction of Laryngotrachea by Partial Cricotracheal Resection for Severe Subglottic Stenosis: Case Report

Abstract

The surgical management of pediatric subglottic stenosis remains a challenging task to pediatric surgeons and otorhinolaryngologists. Children suffering from Myer-Cotton Grades III and IV subglottic stenosis are put in a particularly difficult situation for treatment. Here, we report the case of a ten-year-old girl with severe acquired subglottic stenosis, who was successfully treated. Preoperative bronchoscopy had revealed severe Grade III (95%) stenosis associated with glottic involvement. We performed partial cricotracheal resection and thyrotracheal anastomosis (PCTR) with a stenting T-tube to secure the reconstructed laryngeal lumen and the postoperative airway. The patient was treated in Pediatric Intensive Care Unit (PICU) for a week after surgery with artificial ventilation under heavy sedation. As postoperative bronchoscopy revealed a fragile larynx and mucosal edema, the first trial of T-tube removal was postponed for 6 months, resulting in anastomotic stenosis. She spent the usual childhood at home and in school with T-tube tracheostomy until the removal of the T-tube. The second trial of the T-tube was successfully performed 2 years after surgery, but her persistent hoarse voice remained. PCTR with T-tube stenting is one of the effective and safe definitive procedures for pediatric patients with severe subglottic stenosis (Grades III and IV).