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David R. White, MD; Miguel Bravo, MD; Shyan Vijayasekaran, FRACS; Michael J. Rutter, FRACS; Robin T. Cotton, MD; Ravindhra G. Elluru, MD, PhD

Arch Otolaryngol Head Neck Surg. 2009;135(5):445-447.

Objective  To compare the success rates of laryngotracheoplasty (LTP) with those of anterior cricoid split (ACS) performed over the same period in infants younger than 6 months.

Design  Case-control study.

Setting  Tertiary children's hospital.

Participants  Thirty-two infants younger than 6 months.

Interventions  Twenty-one infants younger than 6 months underwent single-stage LTP as an alternative to tracheotomy, and the outcomes were compared with those in 11 infants who underwent ACS as an alternative to tracheotomy.

Main Outcome Measures  Operation-specific success was defined as extubation without subsequent tracheotomy or revision open-airway procedure.

Results  Infants who underwent LTP had a greater percentage of grade 3 subglottic stenosis (71%-99% obstruction) (P = .02, Fisher exact test). Mean age of patients was similar (3.7 months in the LTP group vs 2.8 months in the ACS group) with no significant difference on t test (P = .12). The operation-specific success rate was 81% (17 of 21) in the LTP group and 27% (3 of 11) in the ACS group (P = .006, Fisher exact test).

Conclusions  Single-stage LTP should be considered the first alternative to tracheotomy when subglottic stenosis is the primary airway lesion. The operation-specific success rate of 81% is comparable to reported operation-specific success rates for LTP in older children.

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston (Dr White); Royal Victoria Eye & Ear Hospital, East Melbourne (Dr Bravo) and Princess Margaret Hospital for Children, Perth (Dr Vijayasekaran), Australia; and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Drs Rutter, Cotton, and Elluru).

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