The growth of circumferential scars of the major airways from infancy to adulthood

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Abstract
The factors affecting the development and prognosis of scarred airwaysin children are presented from a long-term follow-up study of 14 cases oftracheobronchial lesions following either injury or operation. Fourchildren managed by endoluminal treatment developed severe stenosis andrequired treatment, later as adults, by laser resection in 2 cases and bylaryngotracheal plastic enlargement and resection with anastomosis in 1case each. The follow-up of 7 children managed by plastic procedures showedinconsistent results: they were good or excellent in 3 cases but with adecrease in the laryngotracheal diameter of 36%, 28% and 7% respectively.The laryngotracheal calibre decreased in 2 patients to 45% due to partialfibrous stenosis. Resection and anastomosis was required in the remaining 2patients after 11 and 12 years for severe re-stenosis. The 3 patients whounderwent immediate surgical resection all had an excellent clinical andmorphological result, with a decrease in the laryngotracheal diameter ofonly 7%, 13% and 19% after a follow-up of 18, 20 and 15 years,respectively. These results show that the growth capacity of scars inchildren's airways is closely related to residual sclerosis following theinitial treatment. It is thus suggested that primary resection andanastomosis should be performed in as many cases as possible. In theperformance of plastic procedures, special attention should be paid tocomplete resection of the fibrotic tissues. Finally, a very longpostoperative follow-up is always required in children in order to assessthe development of the airway.

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