Thyroid alar cartilage graft in paediatric laryngotracheal reconstruction
Introduction
Since 1970 there have been significant advances in the surgical management of pediatric laryngotracheal stenosis. Numerous external and endoscopic surgical techniques have been described. The single-stage laryngotracheal reconstruction (LTR) using cartilage graft insertion [1] is one of the best accepted techniques.
Different types of graft have been described including costal cartilage [2], [3], [4], hyoid bone [5], auricular cartilage [6], [7], [8], [9], [10] and thyroid cartilage [10], [11], [12]. The theoretical advantage [10], [11] of the thyroid alar cartilage (TAC) graft is its location in the same operative field therefore, potentially reducing operative time and reducing the morbidity of a second operative site. Moreover, its thickness is similar to that of the laryngotracheal cartilages decreasing the possibility of graft prolapse into the lumen. A better inclusion of the graft should decrease the formation of granulation tissue.
The purpose of this study was to analyse a series of 27 infants undergoing laryngotracheal reconstruction using TAC graft interposition, to evaluate the potential of this graft in paediatric laryngotracheal reconstruction.
Section snippets
Materials and methods
The study included all patients referred to our tertiary care institution from February 1999 to May 2003, with a laryngotracheal stenosis requiring a single-stage anterior laryngotracheal reconstruction or with an intralaryngeal tumor requiring a translaryngotracheal removal.
The TAC graft was systematically used in cases of:
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An anterior cricoid expansion for translaryngotracheal treatment of a subglottic lesion.
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A Myer–Cotton [13] grade II or grade III subglottic stenosis without extension to the
Results
Forty-five patients were referred to our centre with a laryngotracheal stenosis requiring a single-stage anterior laryngotracheal reconstruction or with an intralaryngeal tumor requiring a translaryngotracheal removal.
Twenty-seven patients (60%) matched the preoperative criteria for TAC graft use. One patient (no. 5) underwent a TAC graft without fulfilling the criteria because of a severe costal malformation contraindicating the use of costal cartilage graft.
One patient who initially fulfilled
Discussion
Some authors [4], [5], [11], [14] have advocated cartilage graft interposition in paediatric laryngotracheal reconstruction. Better results were obtained with a graft insertion than with a simple cricoid split [5], [14].
Numerous interposition materials have been proposed, including costal cartilage [2], [3], [4], auricular cartilage [5], [6], [7], [8], [9], [10], hyoid bone [3], thyroid alar cartilage [10], [11], [12].
Early ossification of hyoid bone limits its use in infants [3].
The
Conclusion
This study demonstrates that the successful use of TAC graft is possible in laryngotracheal reconstruction surgery in a pediatric population.
Graft stability and evolution are satisfactory and similar to results obtained with other types of graft.
TAC use can significantly reduce the length of the surgical procedure and reduce cosmetic sequelae.
TAC removal did not induce laryngeal deformation, but longer follow-up is necessary to confirm the absence of perturbation of laryngeal growth.
It is
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