Cartilage graft epithelialization. A preliminary study using a goat model
B. J. Wiatrak, D. M. Albert, D. K. Holmes and R. T. Cotton
University of Michigan Medical Center, Ann Arbor.
OBJECTIVE--To determine if the presence of a laryngeal stent adversely
affects the epithelialization of an anterior costal cartilage graft.
DESIGN--Twelve goats underwent laryngotracheoplasty using an anterior
costal cartilage graft. No stent was used in six animals, and a modified
endotracheal tube stent was used in the other six. The degree of
epithelialization in each group was compared histologically, as well as
other histologic criteria (epithelial metaplasia, cilia formation, and
inflammatory cell infiltration). SETTING--Children's Hospital Medical
Center of Cincinnati (Ohio) Medical Research Building. PATIENTS AND OTHER
PARTICIPANTS--No human subjects were used in this study. MAIN OUTCOME
MEASURES--Qualitative histologic analysis of cartilage graft
epithelialization, epithelial metaplasia, cilia formation, and inflammatory
cell infiltration was performed. The stent vs no-stent groups were compared
histologically. RESULTS--In the stented group, one cartilage graft
extruded, while five remained in place. All of the no-stent cartilage
grafts remained in place. A trend was observed in the no-stent group toward
increased cartilage graft epithelialization and cilia formation, while
there was a decrease in epithelial metaplasia and infiltration by
inflammatory cells. CONCLUSIONS--Although the study population was small,
the presence of a laryngeal stent tended to predispose the graft to
increased inflammation and epithelial metaplasia and may adversely affect
cartilage graft epithelialization. The goat may be an adequate animal model
for laryngotracheal reconstruction and, possibly, subglottic stenosis.
