An Evaluation Of Arytenoid Prolapse Following Laryngotracheal Reconstruction

Objectives/Hypothesis: Laryngotracheal reconstruction (LTR) is a collection of procedures used to treat pediatric laryngotracheal stenosis. Arytenoid prolapse is a potential postoperative complication that may lead to upper airway obstruction. This study investigates the incidence, risk factors, and need for surgical intervention for post-LTR arytenoid prolapse. Study Design: Retrospective chart review.Methods: The charts of 107 patients who underwent a total of 119 LTR procedures between 2005 and 2018 at a tertiary free-standing children's hospital were reviewed.Results: The incidence of post-LTR arytenoid prolapse was 7.6%. Age, glottic involvement, tracheostomy status, vocal cord paralysis, and balloon dilation had no effect on arytenoid prolapse development. Sixteen percent of procedures performed in children <8 kg resulted in arytenoid prolapse, versus 4.5% of procedures performed in children >8 kg (P=.036). One hundred percent 100% of patients with post-LTR arytenoid prolapse had placement of a posterior graft. Multivariate analysis confirmed both weight <8 kg and posterior graft use to be significantly associated with arytenoid prolapse (P=.027 and .039, respectively). Three of the nine patients with arytenoid prolapse were symptomatic and weighed <8 kg at time of surgery. One required voice therapy; two required surgical intervention.Conclusions: The incidence of arytenoid prolapse is 7.6% following LTR. Patients undergoing posterior graft LTR or weigh <8 kg at time of surgery are more likely to develop arytenoid prolapse. Children <8 kg at time of surgery who develop arytenoid prolapse are more likely to be symptomatic and require further intervention. These findings are valuable for pre-operative risk assessment of pediatric laryngotracheal stenosis management.