Use of cartilage grafts in the treatment of laryngotracheal stenoses and defects in children.

Stenosis of the laryngotracheal section is in most cases a sequel of intensive care treatment. Most of the children presenting with such stenoses need tracheostomy that in consequence impedes their physical, social and language development. Surgical treatment of stenosis and closure of tracheostomy as early as possible should be strived for. Reconstructive techniques using autogenous cartilage grafts have proved very effective. The aim of our study was to examine the influence of different methods on the structure and function of reconstructed airways. In 23 children between 2 and 16 years suffering from laryngotracheal stenosis we reconstructed the stenotic segments by insertion of autogenous cartilage grafts. Enlargement was achieved by cartilage implantation as a stent into the split cricoid plate in 16 children; in 3 cases we performed enlargement of the anterior wall and in 5 cases instable lateral walls of the trachea had to be reinforced. One child had to be treated with all three techniques at once. In another case the overstretched and soft posterior tracheal wall had to be stabilized. Enlargement of the cricoid plate has proved excellent in cases of a high degree of stenosis of the posterior commissure (Type III and IV of the Cotton classification). Subglottic stenoses Type II can be treated with anterior insertion of cartilage. The use of cartilage in surgical treatment of laryngotracheal stenosis in childhood leads to safe and sufficiently satisfactory results that do not hamper further development of either larynx or trachea.