Safety and Preliminary Efficacy of Posterior External Tracheal Stent Tracheopexy for Severe Tracheomalacia in Children.

Abstract

Objectives: Severe tracheomalacia in children is challenging to manage, and surgical options ranging from tracheostomy to posterior tracheopexy has been performed for treatment of posterior tracheomalacia, with their associated morbidities. The role of posterior external stent tracheopexy (PEXY) has not been established, and we report our experiences in treatment of severe posterior tracheomalacia using PEXY.

Methods: A retrospective review of our case series of three pediatric patients with severe posterior tracheomalacia who underwent PEXY.

Results: Between August 2024 and December 2024, three patients received PEXY. Using bioresorbable external plates as posterior stents, the posterior tracheal myomembrane was sutured to the external stent instead of the anterior longitudinal spinal ligament, minimizing the risk associated with injury of surrounding structures typically encountered during mobilization for spinal ligament access, such as the thoracic duct and esophagus. There were no reported injuries intra-operatively to the recurrent laryngeal nerves and esophagus, and all patients were discharged home within a week after their first post-operative bronchoscopy. All patients reported symptomatic improvement.

Conclusion: We describe a novel procedure accessible to the pediatric otolaryngologist in treatment of severe posterior tracheomalacia using easily available bioresorbable plates molded to the airway as external posterior stents to resist airway collapsibility. Further research and longer-term outcomes are required for the role of PEXY in treatment of posterior tracheomalacia.

Level of evidence: 4 Laryngoscope, 2025.