Chapter 7 - Laryngotracheal reconstruction: surgical management of pediatric airway stenosis

Summary

The management of laryngotracheal stenosis in children poses multiple challenges for clinicians. The open airway laryngotracheal reconstruction (LTR) procedures available to the airway surgeon include anterior cricoid split (ACS), laryngotracheoplasty (LTP) with cartilage grafting, and partial cricotracheal resection (pCTR). This chapter covers a brief description of these, including their indications. The presence of chronic pulmonary disease, often represented by baseline oxygen requirement in bronchopulmonary dysplasia and poor pulmonary functional reserve, prohibits single-stage LTR, necessitating placement of a tracheotomy before or during the LTR. Induction and maintenance of anesthesia for LTR requires careful preparation for and attention to airway management and overall homeostasis. For double-stage patients, meticulous care of the tracheotomy tube is mandatory. Cooperation with a speech and language pathologist to gauge the child's ability to swallow or aspiration risk is critical in postoperative double-stage patients with indwelling stents.