Laryngotracheoplasty as an alternative to tracheotomy in infants younger than 6 months.

OBJECTIVE To compare the success rates of laryngotracheoplasty (LTP) with those of anterior cricoid split (ACS) performed over the same period in infants younger than 6 months. DESIGN Case-control study. SETTING Tertiary children's hospital. PARTICIPANTS Thirty-two infants younger than 6 months. INTERVENTIONS Twenty-one infants younger than 6 months underwent single-stage LTP as an alternative to tracheotomy, and the outcomes were compared with those in 11 infants who underwent ACS as an alternative to tracheotomy. MAIN OUTCOME MEASURES Operation-specific success was defined as extubation without subsequent tracheotomy or revision open-airway procedure. RESULTS Infants who underwent LTP had a greater percentage of grade 3 subglottic stenosis (71%-99% obstruction) (P = .02, Fisher exact test). Mean age of patients was similar (3.7 months in the LTP group vs 2.8 months in the ACS group) with no significant difference on t test (P = .12). The operation-specific success rate was 81% (17 of 21) in the LTP group and 27% (3 of 11) in the ACS group (P = .006, Fisher exact test). CONCLUSIONS Single-stage LTP should be considered the first alternative to tracheotomy when subglottic stenosis is the primary airway lesion. The operation-specific success rate of 81% is comparable to reported operation-specific success rates for LTP in older children.