Abstract

Introduction: Paediatric laryngotracheal stenosis (PLTS) encompasses a variety of congenital and acquired conditions which causes life threatening compromise of the airway, necessitating urgent essential intervention. The incidence of congenital and acquired laryngotracheal stenosis is on the rise. The commonest reason being premature birth owing to prolonged endotracheal intubation.

Methods: This is a retrospective study of 68 children with laryngotracheal stenosis of varied etiology who presented to our tertiary referral institute between June 2006 and December 2017. Various surgical modalities such as laser dilatation, Swiss roll or Montgomery T-Tube insertion, anterior cricoid split, costal cartilage interposition, tracheoplasty etc were employed. A reflection of the surgical management deployed in this cohort is discussed.

Results: All 68 children had meticulous endoscopic evaluation prior to surgical management. 6 (8.8%) patients underwent single stage procedure whereas 62 (91.17%) of patients had multiple procedures. 56 (82.35%) patients had successful decannulation post-treatment. 12 (17.64%) patients had persistent tracheostomy including 5 (7.35%) patients who were lost for follow up.

Conclusion: Paediatric laryngotracheal stenosis continues to pose challenges to the otolaryngologist. This entity requires accurate assessment and treatment needs to be customized for each individual. Our decade of experience managing this difficult entity is based on a rational management protocol as highlighted in this study. Such a systematic approach will give the best outcomes for this difficult entity.

Keywords: Paediatric laryngotracheal stenosis; Laser dilatation; Swiss roll stent; Montgomery T-tube; Costal cartilage interposition; Nitinol stent; Tracheoplasty