gms | German Medical Science

Objective: The standard technique for subglottic stenosis is a cricotracheal resection, which first introduced by Grillo and colleagues. It is associated with good long-term results. However, a high number of operative failures of this technique is reported in the literature when lesions have an advanced side-to-side narrowing and involve the level of the vocal cords. For this kind of stenosis a single-stage laryngotracheal reconstruction (SSLTR) using cartilage interpositions should be performed. Originally, this technique requires a prolonged postoperative stabilization of the reconstructed airway with a stent. Herein, we report our first experience of SSLTR without the need of a prolonged postoperative stenting.

Methods: In 2012, 21 patients underwent airway surgery at the Dept. of Thoracic Surgery, Medical University of Vienna. In 14 patients a cricotracheal resection (CTR) had to be performed due to a subglottic lesion. 12 of these 14 cases were successfully operated following the technique of Grillo. In two cases a sufficient lumen widening could not be achieved by a standard CTR due to a combination of pronounced submucosal thickening and an advanced side-to-side narrowing up to the level of the vocal cords. Thus, the cricoid plate was completely split in the midline and a rib cartilage was interponated to enlarge the subglottic diameter. In order to achieve a firm anchoring of the graft the lateral edges were trimmed in a stepwise fashion. This led to a stable anchoring within the split cricoid. Since the glottic reconstruction was firm without any instability or collapse no stent was inserted.

Results: The perioperative course was uneventful and both patients could be discharged at POD 6 and 10, respectively. The functional outcome was excellent with a normal ventilation, swallowing and voice function 3 months after the operation, as evaluated by bronchoscopy, lung function testing, voice evaluation and structured swallowing tests.

Conclusion: We therefore conclude that a SSLTR is a valid option with good functional results in patients with complex glottic/subglottic stenosis and the technique does not necessarily require a prolonged postoperative stenting.