Partial cricotracheal resection (CTR) for the treatment of subglottic stenosis (SGS) was first reported in an adult by Conley¹ in 1953 and in a child in 1974 by Gerwat and Bryce.² In the early 1990s, the use of CTR in children was championed by Monnier et al,^3-6 beginning with publication of a case series in 1993 and followed by updates, with excellent results. Published results from London,⁷ France,^8,9 and our institution^10-12 have followed, with decannulation rates exceeding 90% for grades III and IV stenosis according to the Myer-Cotton grading system.¹³ With these reports, CTR has become an acceptable, if not preferable, method of treatment for high-grade SGS in children.

Research from JAMA Otolaryngology–Head & Neck Surgery — Nonoperative Management of Complete Tracheal Rings

Posterior glottic stenosis (PGS) is a rare but well-recognized condition that has been classified into 4 subtypes by Bogdasarian and Olson.¹ Although PGS is often seen in conjunction with subglottic stenosis, it also occurs as an isolated condition. The cause is usually attributed to prolonged intubation.^2-4 At present, there is no consensus as to optimal management, and a broad range of treatment modalities have been proposed, including endoscopic techniques such as laser to the posterior glottis,^4-6 laser with cord lateralization,⁷ laser with botulinum toxin,⁸ laser with mitomycin C,⁹ and posterior mucosal advancement flaps,¹⁰ as well as open techniques such as buccal mucosal grafting¹¹ and posterior costal cartilage grafting.^3,12-14 To date, studies have comprised patients with concomitantly occurring PGS and subglottic stenosis and have not specifically addressed the management of pediatric patients with isolated PGS. Thus, our objective was to present our experience with this condition, using posterior cricoid grafting as a management technique.

To discuss the current status of endoscopic airway surgery in children. More refined endoscopic instruments have been introduced, including balloon dilators, powered debriders, lasers with more exact modes of delivery, and innovative suspension laryngoscopes. The use of balloon dilatation for primary management of acquired subglottic stenosis is promising. Microdebriders are now considered a viable option to the CO2 laser for the management of a number of airway diseases. Knowledge regarding supraglottoplasty continues to evolve. Endoscopic vocal cord lateralization is being successfully used at some centers for the management of bilateral vocal cord paralysis. The da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, California, USA) has been introduced to facilitate endoscopic laryngeal cleft repair. Endoscopic airway surgery is presently regaining its early (1960s) popularity. This trend can be attributed to the availability of new and more sophisticated endoscopic instrumentation, the adjunctive use of new pharmaceuticals, and the realization that open and endoscopic techniques can often be used in a complementary fashion.