Laryngeal stenosis in children: Types, grades and treatment strategies Jesús Redondo-Sedano a, 1 , Juan L. Antón-Pacheco b, ⁎, Rocio Morante Valverde c , María López Díaz c , Carmen Luna Paredes d , Leonor Melero Guardia a , Rubén Martín Alelu a , Ignacio Jiménez Huerta e , María Isabel Benavent Gordo a , Andrés Gómez Fraile a a Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain b Pediatric Airway Unit and Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain, Universidad Complutense de Madrid c Pediatric Airway Unit and Pediatric Surgery Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain d Pediatric Airway Unit and Division of Pediatrics, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain e Pediatric Airway Unit and ENT Division, Hospital Universitario 12 de Octubre, Avda. De Córdoba s/n, Madrid 28041, Spain abstract article info Article history: Received 9 July 2018 Received in revised form 15 September 2018 Accepted 17 September 2018 Available online xxxx Key words: Laryngeal stenosis Children Tracheotomy Laryngotracheal reconstruction Partial cricotracheal resection Introduction: Laryngeal stenosis is infrequent in children and usually secondary to endotracheal intubation. The aims of this study were to review the outcomes of the distinct endoscopic and surgical procedures and to suggest a technical modification for one of them. Methods: Retrospective review of patients with the diagnosis of laryngeal stenosis treated in an academic tertiary care institution between 2000 and 2017. The following variables were analyzed: demographic data, endoscopic findings including anatomic type and severity of the lesion, associated anomalies, type of treatment, outcomes, and time of follow-up. Results: Seventy-eight children were included in the study (39 boys) with a median age at diagnosis of 9 months, and 33 (42.3%) showed an associated anomaly. Lesions were acquired in 84.6% of cases and the subglottic region was most frequently involved (77%). Thirty patients (38.4%) had a severe stenosis (Myer-Cotton grades III and IV) and a tracheotomy was performed as an initial treatment in 38 patients (48.7%). Overall, 91% of endoscopically or surgically treated patients showed a good outcome and the decannulation rate in the series was 79.4%. Fourteen patients were managed conservatively. Median follow-up was 29 months (I.R. 10–60 m.) Conclusions: Laryngeal stenosis in children is usually acquired and exhibit a wide range of anatomic presenta- tions. Endoscopic therapeutic procedures may be useful in the management of low grade immature stenosis. Re- constructive surgical techniques may provide a high success rate with an appropriate selection of candidates. © 2018 Elsevier Inc. All rights reserved. Laryngeal stenosis is a rare disorder in children but relatively fre- quent in the setting of prolonged ventilatory support in intensive care units and pediatric airway units. These lesions can be congenital or ac- quired and the subglottic region is most frequently involved [1]. Al- though diagnostic work-up is well established and relies basically on endoscopic findings, comprehensive management guidelines are lack- ing and treatment strategies depend on the particular airway team ex- perience and the specific patient's condition. The objective of this study was to show our experience in the man- agement of children with laryngeal stenosis focusing on the anatomic features, severity, type of treatment and outcomes. Additionally, a mod- ification of one of the reconstructive surgical techniques is proposed. 1. Materials and methods We performed a retrospective review of all patients with the diagno- sis of laryngeal stenosis in our unit between January 2000 and Decem- ber 2017. This study was carried out with the approval of our institutional ethical committee. Clinical charts and laryngo-tracheo- bronchoscopy reports were reviewed, and the following data were col- lected: demographic facts, clinical symptoms, endoscopic findings in- cluding anatomic type and severity of the lesion, associated anomalies, treatment modality, outcomes, and time of follow-up. Main outcome measures were decannulation rate in those patients with a previous tra- cheostomy and clinical improvement in patients without it. Clinical im- provement was defined as disappearance of stridor and better exertion tolerance, a significative relieve of airway obstruction avoiding trache- otomy, and improved pulmonary function tests when available. A neck-chest radiograph was obtained in every case as well as a tra- cheal aspirate sample for microbiological study. Every patient underwent a laryngo-tracheo-bronchoscopy (LTB) even if the diagnosis Journal of Pediatric Surgery xxx (xxxx) xxx ⁎ Corresponding author. E-mail address: janton.hdoc@salud.madrid.org (J.L. Antón-Pacheco). 1 1st author. YJPSU-58917; No of Pages 5 https://doi.org/10.1016/j.jpedsurg.2018.09.027 0022-3468/© 2018 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Pediatric Surgery journal homepage: www.elsevier.com/locate/jpedsurg Please cite this article as: J. Redondo-Sedano, J.L. Antón-Pacheco, R.M. Valverde, et al., Laryngeal stenosis in children: Types, grades and treatment strategies, Journal of Pediatric Surgery, https://doi.org/10.1016/j.jpedsurg.2018.09.027