Predicting graft width in endoscopic cricoid split using endotracheal tube outer diameter: a pediatric case series.

OBJECTIVE

To evaluate the correlation between endotracheal tube outer diameter (ETT OD) and graft width in Endoscopic Posterior Cricoid Split with Rib Graft (EPCS/RG) and propose a predictive model to guide graft size selection.

DESIGN, SETTING, AND

PARTICIPANTS

A retrospective case series involving 12 pediatric patients who underwent EPCS/RG at a tertiary academic center between 2017 and 2024.

MAIN OUTCOMES AND MEASURES: Primary outcome was correlation between ETT OD and graft width. Secondary outcomes included tracheostomy status, postoperative respiratory symptoms, and operative time. Linear regression and Pearson correlation analyses were performed.

RESULTS

The mean patient age was 10.0 ± 4.9 years. The average ETT OD was 7.7 ± 1.67 mm, and the mean graft width was 7.5 ± 1.98 mm. A moderate-to-strong positive correlation was observed between ETT OD and graft width (r = 0.576, p = 0.004). The resulting regression equation was: Graft width = 0.6 + (0.9 × ETT OD). Tracheostomy was avoided in 58.3% of patients, while decannulation of pre-existing tracheostomies was achieved in 16.7% of patients. No significant correlation was found between graft width ratio and operative time (Pearson r = -0.24, p = 0.45).

CONCLUSIONS

ETT OD is a reliable predictor of graft width in EPCS-RG. This data-driven model supports a structured approach to graft sizing, though limited by small number of cases. Further studies with larger sample size are recommended to validate the proposed equation.