Stenting in pediatric airway reconstruction

Diego Preciado

doi:10.1002/lary.23808

Tracheocutaneous Fistula After Pediatric Open Airway Reconstruction

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420987426 ◽

2021 ◽

pp. 000348942098742

Author(s):

Stephen R. Chorney ◽

Joanne Stow ◽

Luv R. Javia ◽

Karen B. Zur ◽

Ian N. Jacobs ◽

...

Keyword(s):

Costal Cartilage ◽

Case Series ◽

Primary Objective ◽

Multivariable Logistic Regression Analysis ◽

Pediatric Airway ◽

Surgical Closure ◽

Laryngotracheal Reconstruction ◽

Airway Reconstruction ◽

Tracheocutaneous Fistula

Objectives: Tracheocutaneous fistula (TCF) is a common occurrence after pediatric tracheostomy decannulation. However, the persistence of TCF after staged reconstruction of the pediatric airway is not well-described. The primary objective was to determine the rate of persistent TCF after successful decannulation in children with staged open airway reconstruction. Methods: A case series with chart review of children who underwent decannulation after double-stage laryngotracheal reconstruction between 2017 and 2019. Results: A total of 26 children were included. The most common open airway procedure was anterior and posterior costal cartilage grafting (84.6%, 22/26). Median age at decannulation was 3.4 years (IQR: 2.8-4.3) and occurred 7.0 months (IQR: 4.3-10.4) after airway reconstruction. TCF persisted in 84.6% (22/26) of children while 15.4% (4/26) of stomas closed spontaneously. All closures were identified by the one-month follow-up visit. There was no difference in age at tracheostomy ( P = .86), age at decannulation ( P = .97), duration of tracheostomy ( P = .43), or gestational age ( P = .23) between stomas that persisted or closed. Median diameter of stent used at reconstruction was larger in TCFs that persisted (7.0 mm vs 6.5 mm, P = .03). Tracheostomy tube diameter ( P = .02) and stent size ( P < .01) correlated with persistence of TCF on multivariable logistic regression analysis. There were 16 surgical closure procedures, which occurred at a median of 14.4 months (IQR: 11.4-15.4) after decannulation. Techniques included 56.3% (9/16) by primary closure, 18.8% (3/16) by secondary intention and 25% (4/16) by cartilage tracheoplasty. The overall success of closure was 93.8% (15/16) at latest follow-up. Conclusions: Persistent TCF occurs in 85% of children who are successfully decannulated after staged open airway reconstruction. Spontaneous closure could be identified by 1 month after decannulation and was more likely when smaller stents and tracheostomy tubes were utilized. Surgeons should counsel families on the frequency of TCF and the potential for additional procedures needed for closure.

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Pediatric Airway Reconstruction at Great Ormond Street: A Ten-Year Review

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949210100602 ◽

1992 ◽

Vol 101 (6) ◽

pp. 465-468 ◽

Cited By ~ 50

Author(s):

James W. Ochi ◽

John N. G. Evans ◽

C. Martin Bailey

Keyword(s):

Costal Cartilage ◽

Laryngotracheal Stenosis ◽

Pediatric Airway ◽

Airway Reconstruction ◽

Cartilage Grafting

One hundred eight consecutive patients with pediatric laryngotracheal stenosis requiring airway reconstruction over a 10-year period were reviewed. One hundred forty-nine operations consisting of 75 laryngotracheoplasties and 74 laryngotracheal reconstructions with costal cartilage grafting were performed. The Cotton grading scheme of preoperative stenosis was useful in predicting likelihood of decannulation. In all, 90 patients (83%) were decannulated.

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SP364 – Feeding and growth after pediatric airway reconstruction

Otolaryngology ◽

10.1016/j.otohns.2009.06.661 ◽

2009 ◽

Vol 141 (3) ◽

pp. P206-P206

Author(s):

Steven Michael Andreoli ◽

David R. White ◽

Shaun A. Nguyen

Keyword(s):

Pediatric Airway ◽

Airway Reconstruction

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Current research in voice and swallowing outcomes following pediatric airway reconstruction

Current Opinion in Otolaryngology & Head & Neck Surgery ◽

10.1097/moo.0b013e3282febd24 ◽

2008 ◽

Vol 16 (3) ◽

pp. 221-225 ◽

Cited By ~ 13

Author(s):

Lisa N Kelchner ◽

Claire Kane Miller

Keyword(s):

Pediatric Airway ◽

Airway Reconstruction ◽

Swallowing Outcomes

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A Sustainable and Scalable Multidisciplinary Airway Teaching Mission: The Operation Airway 10-Year Experience

Otolaryngology ◽

10.1177/0194599820935042 ◽

2020 ◽

Vol 163 (5) ◽

pp. 971-978

Author(s):

Asitha D. L. Jayawardena ◽

Zelda J. Ghersin ◽

Marcos Mirambeaux ◽

Jose A. Bonilla ◽

Ernesto Quiñones ◽

...

Keyword(s):

Dominican Republic ◽

El Salvador ◽

Multidisciplinary Team ◽

Surgical Outcomes ◽

Demographic Data ◽

Operative Procedure ◽

Case Series ◽

The United States ◽

Pediatric Airway ◽

Airway Reconstruction

Objective To address whether a multidisciplinary team of pediatric otolaryngologists, anesthesiologists, pediatric intensivists, speech-language pathologists, and nurses can achieve safe and sustainable surgical outcomes in low-resourced settings when conducting a pediatric airway surgical teaching mission that features a program of progressive autonomy. Study Design Consecutive case series with chart review. Setting This study reviews 14 consecutive missions from 2010 to 2019 in Ecuador, El Salvador, and the Dominican Republic. Methods Demographic data, diagnostic and operative details, and operative outcomes were collected. A country’s program met graduation criteria if its multidisciplinary team developed the ability to autonomously manage the preoperative huddle, operating room discussion and setup, operative procedure, and postoperative multidisciplinary pediatric intensive care unit and floor care decision making. This was assessed by direct observation and assessment of surgical outcomes. Results A total of 135 procedures were performed on 90 patients in Ecuador (n = 24), the Dominican Republic (n = 51), and El Salvador (n = 39). Five patients required transport to the United States to receive quaternary-level care. Thirty-six laryngotracheal reconstructions were completed: 6 single-stage, 12 one-and-a-half-stage, and 18 double-stage cases. We achieved a decannulation rate of 82%. Two programs (Ecuador and the Dominican Republic) met graduation criteria and have become self-sufficient. No mortalities were recorded. Conclusion This is the largest longitudinal description of an airway reconstruction teaching mission in low- and middle-income countries. Airway reconstruction can be safe and effective in low-resourced settings with a thoughtful multidisciplinary team led by local champions.

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