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Otolaryngol Head Neck Surg. 2019 Oct;161(4):652-657. doi: 10.1177/0194599819852619. Epub 2019 Jun 11.

Outcomes of Prophylactic Epiglottic Petiole Suspension at the Time of Complete Laryngofissure.

Author information

1
Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
2
Department of Pediatric Otolaryngology-Head and Neck Surgery, Sainte-Justine Hospital, Montreal, Quebec, Canada.
3
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
4
Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

Abstract

OBJECTIVES:

To compare the clinical outcomes of patients with prophylactic petiole suspension (PPS) at the time of laryngofissure and patients without PPS.

STUDY DESIGN:

Retrospective case series.

SETTING:

Tertiary pediatric hospital from May 2003 to August 2017.

SUBJECTS AND METHODS:

Patients included those undergoing airway reconstruction with complete laryngofissure. Patients in the study group had PPS at the time of laryngofissure, while control group patients did not.

RESULTS:

Eighty-one patients underwent complete laryngofissure (22 study patients, 59 controls) at a median age of 4.8 years (interquartile range, 2.1-9.7). Patients in the control group were younger at the time of the surgery (3.7 vs 6.5 years, P = .04). Other demographic and clinical data, including subglottic stenosis (SGS) grades, were similar. For patients with SGS, 53.8% and 46.2% in the study group had a grade 1-2 and 3-4 SGS, respectively, as compared with 46.2% and 53.8% in the control group (P = .65). Manifestations of petiole prolapse included failure of decannulation (8.6%), exercise intolerance (16.0%), and obstructive sleep apnea (11.1%). After 4 years of follow-up, 4.5% of the study group versus 27.1% of the control group had prolapse of the petiole (P = .04). Petiole prolapsed affected >50% of patients with no PPS after 10 years of follow-up. Patients with petiole prolapse at the first surveillance microlaryngoscopy and bronchoscopy after stent removal had an odds ratio of 10.2 (95% CI, 1.1-94.8; P = .04) of becoming symptomatic.

CONCLUSION:

Patients with PPS had significantly fewer symptoms after complete laryngofissure as compared with patients without PPS. PPS should be considered when a complete laryngofissure is being performed during airway reconstruction.

KEYWORDS:

airway surgery; decannulation; epiglottis; laryngofissure; laryngotracheal reconstruction; laryngotracheoplasty; petiole prolapse; supraglottic stenosis; tracheostomy

PMID:
31184262
DOI:
10.1177/0194599819852619

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