Cervical tracheal resection with cricotracheal anastomosis: experience in adults with grade III–IV tracheal stenosis

Abstract

Introduction: Laryngotracheal stenosis is currently one of the most common complications associated with nasal and orotracheal intubation and tracheotomy. Once established, tracheal stenosis can be a complex and difficult problem to manage.Patients and methods: We retrospectively analysed 2004-2010 data for 12 male patients with postintubation cervical tracheal stenosis (grade III-IV) treated in the otolaryngology department, Mansoura University Hospitals. All patients had a tracheostomy at presentation, and all underwent tracheal resection with primary cricotracheal anastomosis and suprahyoid release.Results: Grade III stenosis was present in five patients (41.7 per cent) and grade IV stenosis in seven patients (58.3 per cent). The length of trachea resected ranged from 2 to 4 cm, representing one to four tracheal rings. In all 12 patients, the procedure allowed successful tracheotomy decannulation. Minor complications comprised surgical emphysema (n = 2) and wound infection (n = 1), and were managed conservatively. Major complications consisted of restenosis (n = 3), managed in two patients by repeated dilatation; one patient was lost to follow up.Conclusion: Segmental tracheal resection with cricotracheal anastomosis was successful in 11/12 (92 per cent) patients with severe cervical tracheal stenosis. The strategy for treatment of airway stenosis is now well established and success rates are high, with minimal or no sequelae.

Laryngotracheal resection and reconstruction for subglottic tracheal stenosis – our experience of 32 cases

“…Cricotracheal resection and thyrotracheal anastomosis along with laryngotracheal reconstruction are now assuming the standard of care for symptomatic subglottic stenosis. This treatment option has been shown to achieve up to 90% decannulation rate in paediatric patients with subglottic stenosis, and 92% in adult patients with severe cervical tracheal stenosis.…”

Tracheolaryngeal resection for cicatricle stenosis

“…При этом от резекции печатки перстневидного хряща мы отказывались, отдавая предпочтение другим вариантам лечения пациентов с РСТ и под-складкового отдела гортани. В литературе есть сообщения о радикальных операциях и в подобных ситуациях [20,35,47]. Однако удовлетворительный опыт ЭРПО позволяет нам придерживаться своего мнения, не подвергая пациента излишнему риску нарушения иннервации гортани и прогрессированию воспалительного процесса в ее хрящах [1,2].…”

“…Летальность после них стала практически аналогична той после ЭРПО: 0,6 и 0,2% соответственно. Частота развития послеоперационных осложнений также существенно снижена и находится на вполне приемлемых для торакальной хирургии уровнях: 14,6 и 2,2% соответственно [3,16,17,24,34,35,39,43,45]. ЭРПО, что подтверждают полученные данные, остаются более безопасными и менее травматичными хирургическими вмешательствами.…”

Treatment of large tracheal defects after resection: Laryngotracheal release and tracheal replacement

“…This releases the laryngotracheal segment from its suprahyoid attachments, permitting downward mobilization. El-Fattah et al[15] carried out cricotracheal resection in 12 patients, removing 2–4 cm in each case. Suprahyoid release was performed on all patients.…”

“…Even in a group of pediatric patients (n = 30), the performance of a laryngotracheal reconstruction did not influence the swallowing function. The growth and the feeding status of the children were normal during the late postoperative period (10 –14 months) [23] In case of a suprahyoidal release, the resection of the hyoid bone has no influence on the swallowing function[15]. …”