Asitha D. L. Jayawardena, MD MPH
Ciersten A. Burks, MD
Christopher J. Hartnick, MD, MS
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.;
Introduction: Persistent suprastomal collapse can be a barrier to tracheostomy decannulation and can require surgical intervention in up to 10% of all pediatric tracheostomy patients. External bioabsorbable stenting can be a reasonable solution for suprastomal collapse, although the material used in bioabsorbable stents, 85:15 poly(L‐lactide‐co‐glycolide), polymer dissolves in 6 months. Unfortunately, limited data exist regarding the long-term outcomes of these procedures. This is a retrospective cohort evaluating the long-term decannulation outcomes of external bioabsorbable microplates in the treatment of suprastomal collapse.
Methods: Hospital records of all patients who underwent a bioresorbable microplate for suprastomal collapse from 2016 to 2019 were reviewed at a single institution. The primary outcome measure was tracheostomy decannulation.
Results: A total of 9 patients underwent placement of bioabsorbable microplates to treat suprastomal collapse. After their initial tracheostomy, 4 patients received an LTR prior to their external stent placement and one patient received a mandibular distraction. The average age at the time of external stent placement was 32 (±21) months, excluding one patient who received their stent at the age of 29 years. 8 patients (88.9%) were successfully decannulated following the procedure. Decannulated patients were followed for an average of 21 (±12.5) months post-operatively and all of these patients have remained decannulated since their initial procedure. This is a total of 173 months (14.4 years) of observation post-procedure in which these patients have remained decannulated. One patient experienced post-operative crepitus requiring washout but still maintained decannulation.
Conclusion: Bioabsorbable microplates have a reasonable chance of long-term successful decannulation when an appropriate patient is selected. Decannulation is maintained beyond the 6 month time frame in which the 85:15 poly(L‐lactide‐co‐glycolide) polymer that comprises the external stent takes to bioabsorb. This procedure should be considered for the often difficult problem of pediatric tracheostomy with isolated suprastomal collapse.