The history of pediatric airway reconstruction.

OBJECTIVES/HYPOTHESIS: To review the history of pediatric laryngotracheal reconstruction and to highlight those who made major contributions in the field.

STUDY DESIGN

Retrospective literature review.

METHODS

A literature search using the PubMed database from 1950 to the present. Earlier references were obtained from the Adams Center, the National Library of Medicine, and Virginia Commonwealth University Library.

RESULTS

A total of 20 articles were identified. The articles reported 274 airway reconstructions of which 79% were in children. Pre-1935 infection was the leading cause of laryngotracheal stenosis. Laryngostomy, pioneered by Chevalier Jackson, was the most common method of reconstruction. Between 1935 and 1970, trauma was the predominant cause of laryngotracheal stenosis. The most common procedure was the anterior/posterior cricoid split or Rethi procedure. It marked the introduction of bony grafts in laryngotracheal surgery as pioneered by Looper. Post-1970, prolonged intubation in neonates was the most common cause of subglottic stenosis. The field was revolutionized by the work of Evans and Cotton, with widespread use of costal cartilage grafts and laryngotracheoplasty leading to a decannulation rate of over 90%. Advances included decreased morbidity, tolerability, shorter recovery time, and fewer stages of reconstruction.

CONCLUSIONS

The pioneering work of many leaders in the field of airway reconstruction over the last 100 years has resulted in a number of effective airway reconstructive procedures that have led to the majority of children being successfully decannulated. In the future, more extensive surgeries, such as tracheal transplantation, may address the small number of children who presently cannot be decannulated.