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A randomized study of suprastomal stents in laryngotracheoplasty surgery for grade III subglottic stenosis in children

Authors

  • Diego Preciado MD, PhD

    Corresponding author
    1. Division of Pediatric Otolaryngology–Head and Neck Surgery, Children's National Medical Center, Washington, DC, U.S.A.
    • Send correspondence to Diego Preciado, MD, Division of Pediatric Otolaryngology–Head and Neck Surgery, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC 20010. E-mail: dpreciad@cnmc.org

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  • The author has no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

Studies comparing the relative effectiveness of suprastomal stents in laryngotracheoplasty surgery are lacking in the literature. The goal of this study was to compare the performance of two widely used short-term suprastomal stents in open airway surgery.

Study Design

Prospective, randomized study of a single surgeon's outcomes for grade III subglottic stenosis (SGS) in children.

Methods

The open Aboulker Teflon stent versus the cut, closed, soft Silastic Montgomery T-tube stent for short-term stenting in double-stage laryngotracheoplasty (dsLTP) were compared.

Results

Twenty-four patients were recruited into the study; 12 received an Aboulker (A) stent and 12 a cut, soft, Silastic (S) stent. There was no statistically significant difference in the operation specific decannulation rate between the two stent groups. Patients who received S stents were found to tolerate postoperative feeding better than those with A stents. The median time to decannulate, however, was longer for those receiving S stents (5.5 vs. 3.5 months, P = .02). Furthermore, those receiving S stents had increased need for airway dilation after stent removal (1.75 vs. 0.17 dilations per patient, P = .02) and increased presence of granulation tissue in the airway at the time of stent removal. Multivariate analysis showed the type of stent used independently correlated to time to decannulate (P = .022).

Conclusions

Compared to the Teflon Aboulker stents, closed, soft, Silastic stents are associated with improved feeding in the postoperative period. Their use, however, also correlates with worsened granulation tissue formation and longer time to decannulation in patients undergoing dsLTP for grade III SGS.

Level of Evidence

1b. Laryngoscope, 124:207–213, 2014

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