Siegel Bianca, Thottam Prasad, Mehta Deepak
Department of Pediatric Otolaryngology, Childrens Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA; Children's Hospital of Michigan, Detroit, MI, USA; Wayne State University School of Medicine Department of Otolaryngology, Detroit, MI, USA.
Department of Pediatric Otolaryngology, Childrens Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA; Children's Hospital of Michigan, Detroit, MI, USA.
Int J Pediatr Otorhinolaryngol. 2016 Mar;82:78-80. doi: 10.1016/j.ijporl.2016.01.006. Epub 2016 Jan 13.
To determine the role of laryngotracheal reconstruction for recurrent croup and evaluate surgical outcomes in this cohort of patients.
Retrospective chart review at a tertiary care pediatric hospital.
Six patients who underwent laryngotracheal reconstruction (LTR) for recurrent croup with underlying subglottic stenosis were identified through a search of our IRB-approved airway database. At the time of diagnostic bronchoscopy, all 6 patients had grade 2 subglottic stenosis. All patients were treated for reflux and underwent esophageal biopsies at the time of diagnostic bronchoscopy; 1 patient had eosinophilic esophagitis which was treated. All patients had a history of at least 3 episodes of croup in a 1 year period requiring multiple hospital admissions. Average age at the time of LTR was 39 months (range 13-69); 5 patients underwent anterior graft only and 1 patient underwent anterior and posterior grafts. Patients were intubated for an average of 5 (range 3-8) days and hospitalized for an average of 12 (range 7-20) days post-operatively. One patient experienced narcotic withdrawal post-operatively, but there were no other post-operative complications. All patients underwent follow-up airway endoscopy within 4 weeks and none required any further dilation procedures. Average post-operative follow-up was 24 months (range 10-48) and none of the patients experienced any further episodes of croup.
Single stage LTR is a safe and effective treatment for recurrent croup in the setting of underlying subglottic stenosis, and should be considered in patients who are refractory to medical management.
