Pediatria pre prax 3/2020
Laryngotracheal stenosis in children – part I Definition, etiology and pathophysiology, clinical manifestations, diagnosis
Paediatric laryngotracheal stenosis (LTS) are congenital or acquired narrowing of the airway affecting the larynx and trachea. They represent a wide group of clinical conditions, which treatment is a challenging problem for children‘s otorhinolaryngologists and thoracic surgeons. The most common causes of congenital PLS are: laryngomalacia (60 %), vocal fold paralysis (15–20 %), subglottic stenosis (10–15 %), laryngeal webs and atresia (5 %), subglottic hemangioma (1,5–3 %), and others. 90 % of acquired pediatric LTS are subsequent to post-intubation injuries. The primary treatment modality is surgical therapy, where we can distinguish between endoscopic procedures and open surgery. Endoscopic treatment, which applies mainly CO2 laser technology and various dilatations systems with additional topical application of mitomycin-C, corticoid and antibiotic ointment, has only limited use in the management of less severe laryngotracheal stenosis. Open surgery, which includes an expansion laryngotracheal reconstruction and partial cricotracheal resection, is a fundamental stone in the treatment of higher levels chronic laryngotracheal stenosis, which usually require tracheotomy. The success of the treatment is significantly influenced by a correct indication for surgery, optimal timing and performance of a surgical treatment, appropriate postoperative care and rehabilitation. This requires a careful preoperative assessment of the patient and then choosing the most appropriate individual comprehensive management. The article provides a general overview of the current theoretical knowledge of etiology, pathophysiology, clinical manifestations, diagnosis and treatment of laryngotracheal stenosis in children with an emphasis on surgical treatment. The aim of the work is to provide comprehensive information about paediatric laryngotracheal stenosis and introduce the current surgical treatment options in the context of their successful use.
Keywords: paediatric laryngotracheal stenosis, endoscopic treatment, laryngotracheal reconstruction, partial cricotracheal resection, management
