The Journal of Thoracic and Cardiovascular Surgery
Volume 140, Issue 3 , Page 723, September 2010

Reply to the Editor

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Lausanne, Switzerland

Article Outline

CTSNet classification: 15

 

We thank Dr Demos for his comment on our article on the management of pediatric subglottic stenosis with glottis involvement.

The management of glotto-subglottic stenosis is challenging, and its surgical management, therefore, has evolved over the years with descriptions of the surgical technique and its modifications, along with the use of stents. The technique we have used in this large pediatric series is different from that described earlier by Demos and colleagues in 1969.1, 2 Notably, this series is the first pediatric series of its kind. The technique combines a subglottic resection and thyrotracheal anastomosis with a posterior cricoid split and costal cartilage graft for glotto-subglottic stenoses. This operation was named “extended partial cricotracheal resection.” The LT-Mold prosthesis is also different in that it calibrates the supraglottic and glottic spaces in the abducted position of the vocal cords, while restoring a triangular shape to the glottis with a sharp anterior laryngeal commissure.3 All currently available stents are round or cigar shaped and do not restore a triangular glottis, especially in the case of vocal cord synechia or grade IV transglottic stenosis. The use of the LT-Mold prosthesis has significantly diminished the incidence of postoperative granulations that require repeat endoscopic/open procedures. This study was therefore a synthesis of our experience of complex pediatric glotto-subglottic stenosis that documents the evolution of the technique with an emphasis on the silicone LT-Mold.

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References 

  1. Demos N, Timmes JJ. Management of benign tumors and obstructions of the subglottic trachea. J Med Soc N J. 1969;66:57–61
  2. Demos N. A method of treating benign stricture of the subglottic trachea. Am Surg. 1969;35:346–347
  3. Monnier P. Airway stenting with the LT Mold: experience in 30 pediatric cases. Int J Pediatr Otorhinolaryngol. 2007;71:1351–1359

PII: S0022-5223(10)00606-9

doi:10.1016/j.jtcvs.2010.06.005

Refers to article:

  • Treatment of subglottic stricture

    Nicholas J. Demos
    The Journal of Thoracic and Cardiovascular Surgery September 2010 (Vol. 140, Issue 3, Page 723)

The Journal of Thoracic and Cardiovascular Surgery
Volume 140, Issue 3 , Page 723, September 2010

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