Current Reconstructive Management of Subglottic Stenosis of the Larynx with Reference to Sixty Consecutively Treated Cases

Abstract

Sixty patients with subglottic stenosis of acquired and nonneoplastic origin were surgically managed by multiple open procedures. Follow-up ranged from 1 to 10 years. Fifty-seven patients had stable and excellent or good results, 2 of them after further surgery, 1 patient had to live with a retained tracheostomy indefinitely and the remaining 2 patients died. While the whole spectrum of surgical modalities employed in this series may not be recommended with total conviction, the authors express their satisfaction with single resection and end-to-end anastomosis which yields invariably good and rapidly obtainable results (22 cases with complete success). Nevertheless, laryngeal enlargement seems to be essential in the case of upper glottic lesions (19 operations provided 19 successes) while primary resection with moulding plasties may be applicable to complex and extended stenoses (19 operations: 16 successful results and 3 failures). With regard to the choice of operation, the authors emphasize the importance of careful preoperative assessment of the lesions which should assure adequate selection of therapeutic methods according to the degree of associated involvement of the trachea, glottis or supraglottic area. Conservative measures including dilatation, electro-coagulation and laser-beam surgery are considered as palliative only, however, they may be useful either in the course of the patient's preparation or in order to achieve more successful postoperative results.

Is Tracheal Stenosis Caused by Percutaneous Tracheostomy Different From That by Surgical Tracheostomy?

“…Both groups were found to have a significant degree of stenosis (95% CI, 3.4 to 6.2 mm; 13.6 to 24.8% in diameter) compared with the average diameter of an adult trachea (25 mm). 8 In the PCT group, there were two cases of tracheoesophageal fistula, while there were none in the SGT group. A more complicated surgical technique (partial cricoid resection with mucosal flap) was more frequently used in PCT group (7 of 15 patients) 8,9 than SGT (1 of 14 patients), although the difference did not reach statistical significance (p ϭ 0.23).…”

The Problem of Pediatric Laryngotracheal Stenosis: A Clinical and Experimental Study on the Efficacy of Autogenous Cartilaginous Grafts Placed Between the Vertically Divided Halves of the Posterior Lamina of the Cricoid Cartilage

“…144 Data comparing the relative amounts of resorption of homograft ear cartilage and autogenous fresh cartilage have not been presented. Clinical success in the use of grafts of autogenous costal cartilage to the posterior lamina of the cricoid cartilage has been reported by Weerda, 3 Cotton, et al, 81 Couraud, et a/., 146 Hof, 147 Maddalozzo and Holinger, 148 Zalzal, 149 and Bailey. 150 Cotton, et al discussed results in 12 children having complete subglottic stenosis, combining division of the lamina of the posterior cricoid cartilage with the use of interposed autogenous cartilaginous graft and long-term stenting with the Montgomery Silastic laryngeal stent.…”

Partial Cricotracheal Resection for Severe Pediatric Subglottic Stenosis: Update of the Lausanne Experience

“…[16][17][18] Most of the cases of dehiscence described in the literature on adults are due to excessive tension on the suture line or to surgery performed in the presence of an infected airway. In children, the position of the larynx high in the neck and the elasticity of the tissues allow an easy mobilization of the trachea.…”