Outcomes of Prophylactic Epiglottic Petiole Suspension at the Time of Complete Laryngofissure
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Mathieu Bergeron, MD, FRCSC, Alessandro de Alarcon, MD, MPH, Catherine K. Hart, MD, Michael J. Rutter, FRACS First Published June 11, 2019 Research Article
https://doi.org/10.1177/0194599819852619
Article information
No Access
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 petiole prolapse, airway surgery, laryngotracheoplasty, laryngotracheal reconstruction, tracheostomy, epiglottis, supraglottic stenosis, decannulation, laryngofissure
Show less
Mathieu Bergeron, MD, FRCSC, Alessandro de Alarcon, MD, MPH, Catherine K. Hart, MD, Michael J. Rutter, FRACS First Published June 11, 2019 Research Article
https://doi.org/10.1177/0194599819852619
Article information
No Access
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 petiole prolapse, airway surgery, laryngotracheoplasty, laryngotracheal reconstruction, tracheostomy, epiglottis, supraglottic stenosis, decannulation, laryngofissure
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