Endoscopic CO2 laser laryngofissure in pediatric laryngotracheal reconstruction

Laser-Assisted Endoscopic Cricotracheal Stenosis Resection (CTSR) in Paediatric Congenital Cartilaginous Subglottic Stenosis

Subglottic stenosis (SGS) in children can be a congenital condition or acquired through injury such as from prolonged intubation. Surgeons face challenges in choosing the best SGS treatment for a particular patient because of variability in the success rate of each technique. Conventional open surgical resection and reconstruction have been proven effective but, in recent years, endoscopic surgery has become more prevalent as it eliminates the incision and reduces the surgery time and subsequent hospital stay. The purpose of this retrospective case study was to report on an endoscopic technique using a CO₂ laser for cricotracheal stenosis resection (CTSR) for high-grade congenital SGS. From forty-five paediatric patients who underwent endoscopic intervention as a primary modality of treatment for high-grade SGS in a tertiary referral centre, a total of eight patients who met the inclusion criteria have been included in our study. This small patient series is the first to use a CO₂ laser alone as a single excision tool to eliminate complex congenital SGS and restore airway patency. The procedure's goal was to return the airway to an early stage of postintubation injury prior to scar formation; therefore, surgical sessions at intervals of 2-3 weeks were performed to ensure natural epithelization, to remove any granulation tissue, and manage fibrosis. Successful treatment was defined as a resolution of symptoms, restoration of a normal patent airway with no stenosis, and decannulation. The success rate was 75%. Two outcomes need to be highlighted. First, the CO₂ laser should be reconsidered as an excision tool for congenital SGS because of its low risk of exacerbating preexisting stenosis. It allows the surgeon to restore and augment the airway without the need for open surgery or dilatation. Second, the shorter interval between procedures is crucial for controlling the healing process and making sure that it is proceeding properly.

Management of congenital tracheal anomalies and laryngotracheoesophageal clefts

Congenital obstructions and anomalies of the pediatric airway are rare problems that may be associated with mild symptoms or critical stenoses that may be life threatening in the first few days of life. This review provides an overview of the embryologic development of the airway, different congenital anomalies associated with airway development, and surgical correction that may be associated with good long-term outcome.