Laryngoplasty with T-tube stenting in the treatment of subglottic stenosis in children

Cover Page

Cite item

Full Text

Abstract

Introduction. Laryngeal stenosis is a congenital or acquired narrowing of the larynx that causes airway obstruction. Approximately 90% of cases of acquired subglottic stenosis in infants and children are due to endotracheal intubation. Laryngotracheoplasty with T-tube placement is a method for treating laryngotracheal stenosis.

Aim. To demonstrate our experience of treating children with stenosis of the subglottic space using laryngoplasty with T-tube placement.

Materials and methods. 53 patients with postintubation laryngeal stenosis are treating in the surgical thoracic department of the National Medical Research Center for Children's Health for the period from 2019 until now. All children were examined. 33 patients underwent laryngoplasty with T-tube stenting.

Results. Nowadays, 18 children have been decannulated after laryngoplasty with T-tube stenting, the rest of the patients continue their treatment.

Conclusion. According to our materials, T-tube stenting is safe and can be an alternative method for treating children with severe acquired laryngeal stenosis.

Full Text

Restricted Access

About the authors

Elena I. Komina

National Medical Research Center for Children's Health

Author for correspondence.
Email: kominaalena@gmail.com
ORCID iD: 0000-0002-9808-8682

Graduate Student

Russian Federation, 119991, Moscow, Lomonosovskiy pr. 2, str. 1

Abdumanap B. Alkhasov

National Medical Research Center for Children's Health; Pirogov Russian National Research Medical University

Email: alkhasov.ab@nczd.ru
ORCID iD: 0000-0003-3925-4991

D. Sci. (Med.)

Russian Federation, 119991, Moscow, Lomonosovskiy pr. 2, str. 1; 117997, Moscow, Ostrovityanova str. 1

Yuri Yu. Rusetski

National Medical Research Center for Children's Health; Central State Medical Academy of the President of the Russian Federation

Email: rusetski@inbox.ru
ORCID iD: 0000-0001-5574-8292

D. Sci. (Med.)

Russian Federation, 119991, Moscow, Lomonosovskiy pr. 2, str. 1; Moscow

Sergei P. Yatsyk

National Medical Research Center for Children's Health

Email: yatsyk@nczd.ru
ORCID iD: 0000-0002-0764-1287

D. Sci. (Med.), Prof., Corr. Memb. RAS

Russian Federation, 119991, Moscow, Lomonosovskiy pr. 2, str. 1

Maksim M. Lokhmatov

National Medical Research Center for Children's Health; Sechenov First Moscow State Medical University (Sechenov University)

Email: lokhmatov@nczd.ru
ORCID iD: 0000-0002-8305-7592

D. Sci. (Med.)

Russian Federation, 119991, Moscow, Lomonosovskiy pr. 2, str. 1; 119991, Moscow, Trubetskaya str. 8, str. 2

Sergey A. Ratnikov

National Medical Research Center for Children's Health

Email: 6193141@gmail.com
ORCID iD: 0000-0003-2082-3998

pediatric surgeon

Russian Federation, 119991, Moscow, Lomonosovskiy pr. 2, str. 1

References

  1. Gyawali BR, Pradhananga RB, Acharya K, et al. Challenges in the management of laryngeal stenosis. Indian J Otolaryngol Head Neck Surg. 2016;68(3):294-9. doi: 10.1007/s12070-015-0936-2
  2. Redondo-Sedano J, Antón-Pacheco JL, Valverde RM, et al. Laryngeal stenosis in children: types, grades and treatment strategies. J Pediatr Surg. 2019;54(9):1933-7. doi: 10.1016/j.jpedsurg.2018.09.027
  3. Fiz I, Monnier P, Koelmel JC, et al. Implementation of the European Laryngological Society classification for pediatric benign laryngotracheal stenosis: a multicentric study. Eur Arch Otorhinolaryngol. 2019;276(3):785-92. doi: 10.1007/s00405-019-05353-4
  4. Rodríguez H, Cuestas G, Botto H, et al. Post-intubation subglottic stenosis in children. Diagnosis, treatment and prevention of moderate and severe stenosis. Acta Otorrinolaringol Esp. 2013;64(5):339-44. doi: 10.1016/j.otorri.2013.03.006
  5. Haranal MY, Buggi S, Sanjeevaiah S, et al. A simplified approach for the management of post-intubation tracheal stenosis. Indian J Thorac Cardiovasc Surg. 2017;33(4):309-15. doi: 10.1007/s12055-017-0536-8.
  6. Maeda K, Ono S, Baba K. Management of laryngotracheal stenosis in infants and children: the role of re-do surgery in cases of severe subglottic stenosis. Pediat Surg Int. 2013;29(10):1001-6. doi: 10.1007/s00383-013-3397-2
  7. Bakthavachalam S, McClay JE. Endoscopic management of subglottic stenosis. Otolaryngol Head Neck Surg. 2008;139(4):551-9. doi: 10.1016/j.otohns.2008.07.024
  8. Shi S, Chen D, Li X, et al. Outcome and safety of the montgomery T-tube for laryngotracheal stenosis: a single-center retrospective analysis of 546 cases. ORL J Otorhinolaryngol Relat Spec. 2014;76(6):314-20. doi: 10.1159/000362244
  9. Разумовский А.Ю., Митупов З.Б. Хирургическое лечение хронических стенозов гортани у детей. Детская оториноларингология. 2012;3:25-30 [Razumovskii AIu, Mitupov ZB. Khirurgicheskoe lechenie khronicheskikh stenozov gortani u detei. Detskaia otorinolaringologiia. 2012;3:25-30 (in Russian)].
  10. Lamb CR. Montgomery T-Tubes. In: Principles and Practice of Interventional Pulmonology. New York: Springer, 2013; p. 331-6. doi: 10.1007/978-1-4614-4292-9_31
  11. Phillips PS, Kubba H, Hartley BEJ, Albert DM. The use of the Montgomery T-tube in difficult paediatric airways. Int J Pediatr Otorhinolaryngol. 2006;70(1):39-44. doi: 10.1016/j.ijporl.2005.05.008
  12. Montgomery WW, Montgomery SK. Manual for use of Montgomery laryngeal, tracheal, and esophageal prostheses: update 1990. Ann Otol Rhinol Laryngol Suppl. 1990;150:2-28. doi: 10.1177/00034894900990s901
  13. Zalzal GH. Stenting for pediatric laryngotracheal stenosis. Ann Otol Rhinol Laryngol. 1992;101(8):651-5. doi: 10.1177/000348949210100804
  14. Maddaus MA, Toth JL, Gullane PJ, et al. Subglottic tracheal resection and synchronous laryngeal reconstruction. J Thorac Cardiovasc Surg. 1992;104(5):1443-50.
  15. Kumar SP, Ravikumar A, Senthil K, et al. Role of Montgomery T-tube stent for laryngotracheal stenosis. Auris Nasus Larynx. 2014;41(2):195-200. doi: 10.1016/j.anl.2013.10.008
  16. Zaima A, Bitoh Y, Morita K, et al. Long-term T-tube stenting as definitive treatment of severe acquired subglottic stenosis in children. J Pediatr Surg. 2010;45(5):996-9. doi: 10.1016/j.jpedsurg.2010.02.035
  17. Stern Y, Willging JP, Cotton RT. Use of Montgomery T-tube in laryngotracheal reconstruction in children: Is it safe? Ann Otol Rhinol Laryngol. 1998;107(2):1006-9. doi: 10.1177/000348949810701202
  18. Jaquet Y, Lang F, Pilloud R, et al. Partial cricotracheal resection for pediatric subglottic stenosis: long-term outcome in 57 patients. J Thorac Cardiovasc Surg. 2005;130(3):726.e1-9. doi: 10.1016/j.jtcvs.2005.04.020
  19. Carretta A, Casiraghi M, Melloni G, et al. Montgomery T-tube placement in the treatment of benign tracheal lesions. Eur J Cardiothorac Surg. 2009;36(2):352-6. doi: 10.1016/j.ejcts.2009.02.049
  20. Puma F, Ragusa M, Avenia N, et al. The role of silicone stents in the treatment of cicatricial tracheal stenoses. J Thorac Cardiovasc Surg. 2000;120(6):1064-9. doi: 10.1067/mtc.2000.110383

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Fiberoptic bronchoscopy: stenosis of the larynx III degree according to the Mayer–Cotton scale.

Download (81KB)
Indexing metadata
3. Fig. 2. Multislice computed tomography: extended stenosis of the subglottic space.

Download (79KB)
Indexing metadata
4. Fig. 3. The back wall of the larynx is dissected.

Download (175KB)
Indexing metadata
5. Fig. 4. The scar is excised, the lumen of the larynx is expanded.

Download (160KB)
Indexing metadata
6. Fig. 5. A T-shaped tube is installed in the lumen of the larynx and trachea.

Download (121KB)
Indexing metadata
7. Fig. 6. The result of treatment of a child with a combination of II degree laryngeal stenosis and laryngeal paresis.

Download (66KB)
Indexing metadata

Copyright (c) 2022 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 74329 от 19.11.2018 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies