Therapeutic effectiveness of costal cartilage grafting into both anterior and posterior walls for laryngotracheal reconstruction in acquired subglottic stenosis.

Background: We have reviewed the surgical procedures performed and outcomes for low-birth-weight infants with acquired subglottic stenosis.
Methods: The gestational age at birth, birth weight, age at Laryngotracheal reconstruction, and therapeutic outcome over the past 26 years were reviewed. Laryngotracheal reconstruction was initially performed by costochondral grafting involving only the anterior wall for the first operation, but since 2010 a costal cartilage was also inserted into the posterior wall of the cricoid cartilage using the BENSON pylorus spreader to split the cartilage.
Results: There were 21 patients. The mean gestational age was 29.6 weeks, the mean birth weight was 1127 g, and the first surgery was performed at a mean age of 37.0 ± 21.8 months. Extubation was possible in 11 of 21 patients (52.3%) after the first surgery and in 7 of 7 patients after re-operation. The total extubation rate reached 100% (18/18) excluding three patients (one who suffered sudden death, and two who were lost to follow-up).
Conclusion: Sufficient dilatation of the subglottic space could not be achieved by costochondral grafting involving the anterior wall alone. The extubation rate was improved by dilatation of the posterior wall and the insertion of costal cartilage into both the anterior and posterior walls.