Surgical treatment of tracheal obstruction in children

47 infants and children with tracheobronchial obstruction requiring surgical treatment are reported. 10 had subglottic stenosis; 17 severe tracheomalacia; 19 intraluminal tracheal stenosis (in 2 of whom it was congenital); 12 granulation tissue or webs; 4 both tracheal stenosis and tracheal fistula; and 1 had a tear of the right main bronchus. The anterior cricoid splitting procedure for the management of severe acquired subglottic stenosis was performed in 10, in 2 of whom it failed and tracheostomy was required. Aortopexy was performed in 14 cases and pulmonary arteriopexy in 1. A rib cartilage graft and a prosthetic splint fabricated from Marlex mesh were applied in 2 cases after failed aortopexy. The 19 patients with tracheal stenosis were treated as follows: tracheal splitting with autologous free tibial periosteal graft was used in 2 infants; transbronchoscopic resection was successful in 12 children; wedge resection of the tracheal fistula and anterior anastomosis was done in 4; segmental tracheal resection with end-to-end anastomosis in 1; and suture of a bronchial tear was performed in 1. There was no operative mortality; 2 patients died; but the deaths were not directly related to surgery. In our experience, the surgical approach is both safe and expedient in relieving tracheal obstruction in most infants and children.