Endoscopic Posterior Cricoid Split and Costal Cartilage Graft Placement in Children

Abstract

Objectives

To review a multi-institutional experience using endoscopic posterior cricoid split and costal cartilage graft (EPCSCG) placement in the management of pediatric bilateral vocal fold immobility (BVFI), posterior glottic stenosis (PGS), and subglottic stenosis (SGS).

Design

Case series with chart review.

Setting

Tertiary medical centers.

Methods

Review of all patients treated between 2004 and 2012 with EPCSCG placement in 3 academic and multispecialty group settings. The main outcomes measured include indications, complications, and outcome (need for additional procedures, decannulation rate).

Results

A total of 28 patients underwent EPCSCG. Age range at time of surgery was 1 month to 15 years (mean, 56 months). Overall, 25 of 28 were decannulated or never required tracheostomy, and 24 of 28 had adequate symptom control with mean follow-up of 25 months. Twenty-two patients had resolution of their symptoms without additional procedures. Sixteen patients had SGS in isolation or in combination with cricoarytenoid fixation, glottic stenosis, or vocal fold immobility. Decannulation and/or symptom control was achieved in 14 of 16. Three patients had isolated PGS or cricoarytenoid fixation with all achieving decannulation. Nine patients had isolated BVFI with 7 being able to achieve resolution of their airway symptoms, 5 without additional procedures.

Conclusion

This descriptive series shows a consistent outcome in more than double the number of cases previously reported in the previously published series. We believe that EPCSCG is an important option to have in the management of pediatric glottis/subglottic stenosis and bilateral vocal fold immobility.

Keywords

pediatric vocal fold paralysis and immobility subglottic stenosis endoscopic minimally invasive treatment costal cartilage graft cricoarytenoid joint fixation laryngotracheal reconstruction

Get full access to this article

View all access options for this article.

References

Cotton

. The problem of pediatric laryngotracheal stenosis: a clinical and experimental study on the efficacy of autogenous cartilaginous grafts placed between the vertically divided halves of the posterior lamina of the cricoid cartilage. Laryngoscope. 1991;101(12, pt 2)(suppl 56):1-34.

Gray

Kelly

Dove

. Arytenoid separation for impaired pediatric vocal fold mobility. Ann Otol Rhinol Laryngol. 1994;103:510-515.

Inglis

Perkins

Manning

Mouzakes

. Endoscopic posterior cricoid split and rib grafting in 10 children. Laryngoscope. 2003;113:2004-2009.

Thakkar

Gerber

. Endoscopic posterior costal cartilage graft placement for acute management of pediatric bilateral vocal fold paralysis without tracheostomy. Int J Pediatr Otorhinolaryngol. 2008;72:1555-1558.

Provenzano

Hulstein

Solomon

. Pediatric endoscopic airway management with posterior cricoid rib grafting. Laryngoscope. 2011;121:1062-1066.

Myer

III O’Connor

Cotton

. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhin Laryngol. 1994;103:319-323.

Ward

Gordon

Rabkin

April

. Modifications of airway reconstruction in children. Ann Otol Rhinol Laryngol. 1998;107:365-369.

Hartnick

Brigger

Willging

Cotton

Myer

. Surgery for pediatric vocal cord paralysis: a retrospective review. Ann Otol Rhinol Laryngol. 2003;112:1-6.

Ezzat

Shehata

Kamal

Riad

. Adjustable laterofixation of the vocal fold in bilateral vocal fold paralysis. Laryngoscope. 2010;120:731-733.

10.

Rutter

Cotton

. The use of posterior cricoid grafting in managing isolated posterior glottic stenosis in children. Arch Otolaryngol Head Neck Surg. 2004;130:737-739.