- Design
- retrospective single-centre cohort at a tertiary paediatric airway reconstruction centre
- Population
- 25 children undergoing 28 procedures for suprastomal collapse; mean age 6.3 years (range 0.8-21.2)
- Primary outcome
- successful decannulation
- Effect
- 92% overall; 18/18 anterior or combined, 3/4 posterior, 3/3 lateral
Suprastomal collapse after paediatric tracheostomy has tended to be treated as a single entity blocking decannulation. A tertiary paediatric airway centre reviewed 25 consecutive children undergoing 28 operative corrections between December 2020 and July 2024, and reports a framework built on classifying the collapse before choosing the operation.
The assessment is the method. Every child had rigid bronchoscopy followed by dynamic flexible bronchoscopy after the tracheostomy tube was removed — the second part being what reveals how the segment behaves without the tube splinting it. Collapse was then classified as anterior, posterior, lateral or combined according to dynamic behaviour, segment length and cartilage integrity.
Operative selection followed the phenotype. Eighteen children with anterior or combined collapse were treated by primary anterior closure (5), anterior external bioresorbable stent reinforcement (4), tracheal resection and reconstruction (7) or slide tracheoplasty (2); all were decannulated. Posterior collapse (4 children) was treated with posterior external stent tracheopexy, with 75% decannulated, and lateral collapse (3 children) with vertical external stenting, with all decannulated. Overall decannulation was 92%.
The numbers within each phenotype are small enough that none of the individual success rates carries weight — four children and three children are case series, not comparisons. What the report supports is the assessment step rather than any particular operation: dynamic bronchoscopy with the tube out, before planning, and a decision about which direction the airway is failing in. That costs nothing but a change in how the examination is done, and it is available anywhere rigid and flexible bronchoscopy are.
- Perform dynamic flexible bronchoscopy with the tracheostomy tube removed before planning correction of suprastomal collapse
- Classify the collapse by direction — anterior, posterior, lateral or combined — and by segment length and cartilage integrity
- Choose the operation from the phenotype rather than applying a single default technique
- Treat the per-phenotype success rates with caution; some groups contained only three or four children
- Refer to a centre with paediatric airway reconstruction capability where resection or slide tracheoplasty may be needed
Why it matters
The decision that has been made by surgeon preference turns out to have four distinguishable answers.
Don't overread it
A single-centre series with three or four children per phenotype cannot show that phenotype-directed selection outperforms a standard approach.
The statistics, in plain English
An overall decannulation rate of 92% comes from 25 children, so it rests on two failures; a single additional failure would move it several percentage points. The phenotype subgroups are smaller still — 75% in the posterior group means three of four children — and percentages on that base should be read as the raw counts they are. With no comparison group treated by a single default technique, the framework cannot be shown to be better than what it replaced.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for ent & head and neck surgery, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free