Diagnosis and Management of Suprastomal Collapse After Pediatric Tracheostomy: A Phenotype-Directed Surgical Algorithm.

OBJECTIVE: To report institutional outcomes in pediatric suprastomal collapse and to describe a structured, phenotype-directed diagnostic and surgical management framework grounded in dynamic airway assessment and morphology-based operative selection.7,19 STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary pediatric airway reconstruction center. METHODS: Consecutive pediatric patients undergoing operative correction of suprastomal collapse between December 2020 and July 2024 were reviewed. All patients underwent rigid bronchoscopy followed by dynamic flexible bronchoscopy after tracheostomy tube removal. Collapse was classified as anterior, posterior, lateral, or combined according to dynamic behavior, segment length, and cartilage integrity. Operative intervention was selected based on phenotype and structural characteristics. The primary outcome was successful decannulation. RESULTS: Twenty-five patients underwent 28 procedures. Mean age at first intervention was 6.3 years (range 0.8-21.2 years). Anterior or combined collapse was present in 18 patients and treated with primary anterior closure (n = 5), anterior external bioresorbable stent reinforcement (n = 4), tracheal resection and reconstruction (n = 7), or slide tracheoplasty (n = 2); all were successfully decannulated. Posterior collapse (n = 4) treated with posterior external stent tracheopexy achieved 75% decannulation. Lateral collapse (n = 3) treated with vertical external stenting achieved 100% decannulation. Overall decannulation success was 92%. CONCLUSION: Suprastomal collapse represents a heterogeneous spectrum of localized airway instability rather than a uniform pathologic entity. Phenotype-directed operative selection based on dynamic bronchoscopic classification is associated with favorable decannulation outcomes and offers a reproducible framework for surgical decision-making.