International Journal of Pediatric Otorhinolaryngology
Case reportPolyflex™ stenting of tracheomalacia after surgery for congenital tracheal stenosis
Introduction
Management of complex airway pathology in children is difficult and requires a dedicated multidisciplinary approach. We describe our experiences with several children with long-segment tracheal stenosis and the use of Polyflex stenting to manage malacia after failed surgical correction.
Section snippets
Case 1
A 17-month-old child presented with severe airway obstruction exacerbated by viral infection. Stridor from 3 months of age was due to 2 mm long-segment stenosis involving five complete rings and right main bronchial stenosis (3.5 mm) associated with left pulmonary artery sling. Veno-arterial extracorporeal membrane oxygenation (v-aECMO) was required after failure of conventional mechanical ventilation and high frequency oscillatory ventilation.
The sling was repaired and slide tracheoplasty
Comment
Management of long-segment congenital tracheal stenosis and malacia is determined by the degree of obstruction, length of involvement, involvement of the bronchi and presence or absence of complete tracheal rings [1].
Initial slide tracheoplasty [2] is recommended for medium-length stenosis (<2/3 trachea) with 28 survivors among 32 cases [1]. For long-segment stenosis, slide tracheoplasty with patch is required. Numerous patch materials and tissues have been utilised with good results from
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Cited by (10)
External airway splint placement for severe pediatric tracheobronchomalacia
2023, International Journal of Pediatric OtorhinolaryngologyTracheobronchial stents in children
2016, Seminars in Pediatric SurgeryCitation Excerpt :Their final recommendation was to use them in a short-term basis and to select the largest possible stent diameter allowing complete unfolding within the airway.21 The use of other types of plastic stents has been occasionally reported in children.5,56 The Montgomery T-tube requires a surgical tracheotomy and may be indicated as a temporary measure to stabilize a laryngotracheal reconstruction in older children.57
Management of congenital tracheal anomalies and laryngotracheoesophageal clefts
2014, Seminars in Pediatric SurgeryCitation Excerpt :Simple dilation of a congenital airway stenosis as a primary treatment rarely has a lasting effect. We discourage the use of stents as a primary therapy, because they can lead to damage of the airway that may prevent or complicate a successful reconstruction either by resection or slide tracheoplasty, although there are reports of success.36–40 Many of the current stents will cause granulation tissue formation or become covered with normal-appearing mucosa, making removal quite dangerous.
Interventions in the Chest in Children
2011, Techniques in Vascular and Interventional RadiologyCitation Excerpt :Silicone stents (Dumon; Novatech, Aubagne, France) are unpopular in small children, mainly because they partially occlude the airway and sometimes migrate,23 but newer, thin-walled designs may reverse this trend. There is only limited experience with a plastic self-expanding stent (Polyflex; Rüsch, Kernen, Germany).24,26 Most centers now use metal stents.
Pediatric Tracheal Stenosis
2008, Otolaryngologic Clinics of North AmericaCitation Excerpt :In addition they often are deployed with balloon dilation to complement open tracheoplasty, to treat restenosis after surgical failure, and to assist in palliation. The choice of stent relies on local expertise in insertion and removal, the propensity of the stent to migrate or erode into the airway wall, the wall thickness, and the availability of appropriate sizes and shapes [49]. Perhaps the biggest problem is the tendency of stents to stimulate granuloma formation (Fig. 10A and B).
Management of symptomatic congenital tracheal stenosis in neonates and infants by slide tracheoplasty: A 7-year single institution experience
2010, European Journal of Cardio-thoracic Surgery