Pediatric Tracheal Stenosis Allen S. Ho, MD a , Peter J. Koltai, MD, FACS, FAAP b, * a Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Lucile Packard Children’s Hospital, Stanford University Medical Center, 801 Welch Road, Palo Alto, CA 94305, USA b Division of Pediatric Otolaryngology, Stanford University, School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA Congenital tracheal stenosis is characterized by structural tracheal constriction. It encompasses a wide range of manifestations, can involve short or long segments, and is associated with pulmonary, cardiovascular, and gastrointestinal malformations. The condition is infrequent, with inci- dence estimated to be 1 in 64,500 [1], and represents only 0.3% to 1% of all laryngotracheal stenosis [2]. Most are severe in nature: before the advent of current surgical techniques, mortality was reported to be as high as 79% [3], mainly because of acute airway obstruction and the lack of effective medical treatment. Tracheal resection and re-anastomosis existed as a solu- tion as early as the late nineteenth century but was contraindicated for stenotic segments longer than 2 cm because of the risk of excess tension. Tracheal release maneuvers developed in the 1950s later extended the resect- able length to 25% to 30% of the trachea [4], and the introduction of cardiopulmonary bypass and the Montgomery T-tube (Boston Medical Products, Westborough, Massachusetts) (used as a stent as well as tracheos- tomy tube) began to address the intra- and postoperative complications frequently seen with tracheal stenosis. By 1982, Kimura and colleagues [5] introduced the costal cartilage tracheoplasty for long stenotic segments. Their work was followed in 1984 by Idriss and colleagues [6], who described the pericardial patch tracheoplasty. Problems with granulation formation and prolonged postoperative intubation were addressed when the slide tracheoplasty was proposed in 1989 by Tsang and colleagues [7] and modified by Grillo [8]. The evolution of these surgical techniques has improved outcomes significantly for previously inoperable patients. In addition, better * Corresponding author. E-mail address: pkoltai@ohns.stanford.edu (P.J. Koltai). 0030-6665/08/$ - see front matter Ó 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.otc.2008.04.006 oto.theclinics.com Otolaryngol Clin N Am 41 (2008) 999–1021