Novel Method for Laryngotracheal Reconstruction: Combining Single- and Double-Stage Techniques. (July 2013)

• Record Type: Journal Article
• Authors: Setlur, Jennifer; Maturo, Stephen; Hartnick, Christopher J.
• Is Part Of: Annals of otology, rhinology & laryngology. Volume 122:Number 7(2013)
• Page Start: 445
• Page End: 449
• Publication Date: 2013-07
• Subjects: airway surgery -- laryngotracheal reconstruction -- pediatrics -- subglottic stenosis -- tracheostomy; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/000348941312200706
• Languages: English
• ISSNs: 0003-4894

Abstract

Objectives: Traditional open techniques for laryngotracheal reconstruction are either single- or double-stage procedures. Some patients may benefit from the presence of a long, single-tube stent, such as an endotracheal tube, but their predicted need for a 2-stage procedure and a persistent tracheostomy is high. We describe a novel technique for airway reconstruction that combines the methods of both single- and double-stage procedures. Methods: We present a retrospective review of 4 patients. All patients underwent laryngotracheal reconstruction by a single surgeon. After the operation, the airway was stented with nasotracheal intubation. A small stent, fashioned from an endotracheal tube, was placed in the tracheostoma to keep it patent. The patients subsequently underwent extubation and replacement of the tracheostomy tube. Results: The study included 1 patient with grade 4 subglottic stenosis, 2 patients with grade 3 subglottic stenosis, and 1 patient with a posterior glottic scar. All were tracheostomy tube-dependent. Serial bronchoscopy was used to follow the patients for a minimum of 9 months after the operation. All 4 patients have since met the criteria for decannulation. Conclusions: This hybrid reconstruction merges the advantages of both the single- and double-stage procedures. It adds versatility to the surgical toolbox for airway reconstruction.