Pediatric primary anterior laryngotracheoplasty: Thyroid ala vs costal cartilage grafts

Objective: To compare outcomes with the use of thyroid ala cartilage (TAC) and costal cartilage (CC) grafts in pediatric primary anterior laryngotracheoplasty (LTP). Design: Retrospective comparison study. Setting: Tertiary, academic children's hospital. Patients: Of 45 laryngotracheal operations performed between June 2001 and October 2008 for laryngotracheal stenosis, 29 were primary anterior LTPs. The procedures used either TAC (n=24) or CC (n=5) grafts and were planned as either single-stage (TAC group, 22 patients; CC group, 2 patients) or multistage (TAC group, 2 patients; CC group, 3 patients). Main Outcome Measures: Operative time, length of intubation, graft-specific complications, need for additional airway procedures, and overall decannulation rate. Results: The mean (SD) operative times were 222 (56) minutes for TAC grafts and 363 (59) minutes forCCgrafts (P=.005). For single-stage LTPs that were decannulated, the mean (range) length of intubation was 3.3 (1-11) days for TAC grafts (n=18) and 3 (1-5) days for CC grafts (n=2) (P=.90). Graft-specific complications occurred in 17% of TAC grafts (n=4) and 20% of CC grafts (n=1) (α>0.05). Symptomatic stenosis requiring additional surgical intervention occurred in 43% of TAC grafts (n=10) and 60% of CC grafts (n=3) (α>0.05). Patients underwent decannulation in 83% of TAC grafts (n=19) and 80% of CC grafts (n=4) (α>0.05). Conclusions: In primary anterior LTPs, TAC grafts require significantly less operative time than CC grafts (P=.005). There were no statistically significant differences in length of intubation, frequency of graft-specific complications, or decannulation rates between TAC and CC grafts in primary anterior LTPs.