(447) Single and Multi-staged Approach to Posterior Cricoid Reduction Post-Pediatric Laryngotracheoplasty

Introduction: This report aims to provide evidence of the efficacy and safety of Endoscopic Posterior Cricoid Reduction in the pediatric patient population including the youngest documented patient through a single or multi-staged approach.

Methods: In this series we review patients ranging from 3 to 8 years of age who previously underwent single-staged approach laryngotracheal reconstruction with anterior and posterior costal cartilage grafts for grade 3 subglottic stenosis complicated by post-operative dysphonia and posterior glottic diastasis. Given the known effects of dysphonia on quality of life, with careful counseling of the patients' respective families plans were made to proceed with posterior cricoid reduction by way of either a single or multi-staged approach. Endoscopic posterior cricoid reduction was performed either via an endoscopic CO2 laser approach or sharp excision. Subsequent qualitative assessments of dysphonia and measurements of the airway were performed to assess outcomes.

Results: Pre-operatively, the patients had 6-7mm posterior glottis apertures. Post-operative measurements showed a reduction to 4-6mm in each of the cases. One patient underwent a staged, second procedure after allowing time for tissue growth and maturation; her post-operative measurement was 4mm. One of the patients required a return to the operating room for removal of granulation tissue at the suture site. At completion of reconstruction, each of the 3 patients had a clinically appropriate glottic opening without stridor, shortness of breath or airway obstruction. All patients demonstrated significantly improved and strengthened quality of voice post-operatively.

Conclusions: Single and Multi-staged Endoscopic Posterior Cricoid Reduction (EPCR) are viable options for safe and effective methods of rehabilitating dysphonia in younger pediatric patients with posterior glottic diastasis. The reduction can be approached in a staged fashion to reduce the possibility of over-reduction of the posterior cricoid graft.