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Michael J. Cunningham, MD; Roland D. Eavey, MD; Gus J. Vlahakes, MD; Hermes C. Grillo, MD

Arch Otolaryngol Head Neck Surg. 1998;124:98-103.

Objective  To introduce a novel surgical technique for the repair of congenital long-segment tracheal stenosis.

Design  Retrospective case series.

Setting  Tertiary-care hospital.

Patients  Three children ranging in age from 3 months to 3 years, all with complete tracheal rings, the stenotic segments representing between 36% and 49% of the total tracheal length. One patient had an anomalous right upper lobe bronchus and an associated pulmonary artery sling.

Intervention  Slide tracheoplasty reconstruction.

Main Outcome Measure(s)  Postoperative clinical status as evidenced by day and site of extubation, duration of hospitalization, number of bronchoscopic examinations performed before discharge, and subsequent need for urgent bronchoscopic examinations, which reflects the adequacy of the reconstructed airway.

Results  Two patients were extubated on the day of surgery, 1 intraoperatively; the child with the pulmonary artery sling required 3 days of elective intubation for postoperative ventilatory support. The duration of hospitalization ranged from 8 to 10 days. All patients underwent elective bronchoscopy once before discharge; none had granuloma formation. Follow-up ranged from 1 to 4 years. One patient required a single urgent bronchoscopic examination in addition to planned surveillance endoscopy. Growth of the reconstructed hemitracheal rings is demonstrable.

Conclusions  Slide tracheoplasty achieves successful tracheal reconstruction using the patient's own tracheal tissues. Advantages of this method include the potential avoidance of cardiopulmonary bypass, immediate or early postoperative extubation, and the near-complete absence of granulation tissue formation. The latter obviates the need for multiple postoperative bronchoscopic examinations, as has been reported in tracheoplasty procedures using either costal cartilage or pericardium.

From the Department of Otolaryngology, Massachusetts Eye and Ear Infirmary (Drs Cunningham and Eavey), and the Thoracic (Dr Grillo) and Cardiac (Dr Vlahakes) Surgical Units, Department of Surgery, Massachusetts General Hospital, the Harvard Medical School, Boston, Mass.

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