Department of Otorhinolaryngology and Head & Neck Surgery, University of Szeged, Szeged, Hungary.
Department of Pediatrics and Pediatric Health Center, University of Szeged, Szeged, Hungary.
Laryngoscope. 2020 Apr;130(4):E199-E205. doi: 10.1002/lary.28192. Epub 2019 Jul 27.
Subglottic stenosis is the most common laryngeal anomaly necessitating tracheostomy in early childhood. Crico- and laryngotracheal resection and laryngotracheal reconstruction-usually with autologous cartilage graft implantation-are the most effective treatments. These surgical techniques are obviously challenging in neonatal age and infancy. However, a reconstructive surgery performed at early age may prevent the sequel of complications.
The authors present their novel surgical method for congenital subglottic stenosis. Seven infants had inspiratory stridor; two of them had to be intubated and one required tracheostomy. Laryngotracheoscopy, CT or MRI revealed subglottic stenosis: Cotton-Myer grade II in one, and grade III in six cases. Slide laryngotracheoplasty was performed before 5 months of age (10-130 days), with a follow-up period of average 36 months (4-80 months). Phoniatry and quality of life questionnaire were used for evaluation of postoperative results.
Slide laryngotracheoplasty in the neonatal age made the temporary tracheostomy unnecessary. All babies remained intubated for 3 to 10 days with an uncuffed tracheal tube. After extubation, no dyspnea or swallowing disorder occurred. A subjective quality of life questionnaire, laryngotracheoscopy, clinical growth charts showed satisfactory functional results.
Single-stage slide laryngotracheoplasty might be a favorable solution for subglottic stenosis, even in early childhood. In one step, the airway can be maintained without stenting and tracheostomy.
4 Laryngoscope, 130:E199-E205, 2020.
声门下狭窄是小儿早期最常见的需行气管切开术的喉部异常。环甲和喉气管切除术联合喉气管重建术，通常采用自体软骨移植，是最有效的治疗方法。这些手术技术在新生儿和婴儿期明显具有挑战性。然而，早期进行重建手术可能会预防并发症的发生。
作者介绍了一种治疗先天性声门下狭窄的新手术方法。7 名婴儿存在吸气性喘鸣，其中 2 名需要插管，1 名需要气管切开。喉气管镜检查、CT 或 MRI 显示声门下狭窄：1 例为 Cotton-Myer Ⅱ级，6 例为Ⅲ级。7 例患儿均在 5 月龄前（10-130 天）进行滑动喉气管成形术，平均随访 36 个月（4-80 个月）。术后采用嗓音学和生活质量问卷进行评估。
新生儿期进行滑动喉气管成形术可避免临时气管切开。所有患儿均在带套囊的气管导管中保留插管 3-10 天。拔管后无呼吸困难或吞咽障碍。主观生活质量问卷、喉气管镜检查和临床生长图表显示功能结果满意。
单阶段滑动喉气管成形术可能是小儿声门下狭窄的一种有利解决方案。一步即可完成气道的维持，无需支架和气管切开。
4.喉镜，130：E199-E205，2020 年。
