Paediatric Laryngotracheal Stenosis

Laryngotracheal stenosis in infancy and childhood is challenging in many aspects. Diagnosis and therapy require specific expertise and must be tailored to the individual case. The most important presentations of airway pathology in children are presented in this paper. Conservative, endoscopic and surgical treatment options are discussed. Laryngomalazia is the most frequent condition of supraglottic stenosis. The term supraglottoplasty summarizes all different techniques used for it's repair using an endoscopic approach. Glottic stenosis is rare in children. Usually a compromise between voice preservation and airway restoration has to be sought. Type of reconstruction and timing are varying considerably in individual cases, endoscopic approaches should be preferred. Subglottic stenosis remains the largest group in paediatric airway pathology, with cicatrial stenosis being predominant. Today, cricotracheal resection is the most successful treatment option, followed by the classical laryngotracheal reconstruction with autologous cartilage. In early infancy subglottic stenosis is particularly demanding. Endoscopic treatment is possible in selected patients, but open reconstruction is superior in more severe cases. Subglottic stenosis in children requires expertise and experience in diagnosis and treatment. Considering the limited incidence these cases should be managed in a referral center.