One-stage laryngotracheal reconstruction in young infants
By Madhup K Chaurasia

Airway inadequacy is a significant problem in young infants and may go undetected until inflammatory conditions trigger acute episodes, some of which require a tracheostomy. In addition to breathing difficulties, feeding problems are also common. This study involves 11 children aged six to 11 months who required surgical widening of the airway. For all these infants, the authors chose to use thyroid cartilage to implant and augment the subglottic air passage. The advantage of this approach is that it requires only a single operating site, whereas cartilage taken from the costal rib, nose and auricle involves two sites. Of course, the amount of cartilage obtainable from the thyroid ala is limited. The evaluation of the narrowed airways was done by applying the Myer-Cotton method and choosing either grade II or III as appropriate for this procedure. The infants required intubation for only two weeks, with the tube being changed after the first week. All of them developed pyrexia and granuloma following surgery but this cleared with the use of budesonide. Steroids were withheld so as not to impair healing. Short intubation for only two weeks adds to the merit of a single-stage procedure compared to intubation for three to six months in staged procedures. However, this approach requires more intensive perioperative and nursing care. The successful outcomes in all 11 children lend credibility to this method.

One stage thyroid cartilage laryngotracheal reconstruction for children less than one year old with congenital subglottic stenosis.
Chen C, Ni Y, Tan L, et al.
J LARYNGOL OTOL
2024;138(10):1008–12.