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March 1990

Update of the Cincinnati, Ohio, Experience With Pediatric Laryngotracheoplasty

Author Affiliations

Birmingham, Ala

Arch Otolaryngol Head Neck Surg. 1990;116(3):257. doi:10.1001/archotol.1990.01870030021002

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Dr Robin T. Cotton, Cincinnati, Ohio, presented his experience with 203 cases of subglottic stenosis operated on during the preceding 10 years. The results were presented at the 1989 Triological Society meeting in San Francisco, Calif, by Dr Cotton, and his associates, Robert P. Miller, MD, Chicago, Ill, and Steven Gray, MD, Iowa City, Iowa. Noting the absence of uniform grading for subglottic stenoses, Dr Cotton presented his staging system as follows: grade I, less than 70% obstruction of the airway; grade II, 70% to 90% obstruction; grade III, 90% to 99% obstruction; and grade IV, total airway obstruction. Methods of reconstruction include anterior costal grafting (189 cases), posterior costal grafting, the modified Rethi procedure with stenting (65 cases), posterior cricoid splitting with anterior-posterior grafting, and the Evans castellation procedure.

Dr Cotton noted that in his 98 grade II cases 95% were decannulated, with 83% requiring only one procedure. Further,

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