The anterior cricoid split in puppies

Abstract

The acute and long-term effects of the anterior cricoid split on the subglottis of puppies intubated from 7 to 14 days are documented. The anterior cricoid split acutely increased the intralumenal cricoid surface area in puppies with intubation-induced airway injury. An intense inflammatory response with mucosal ulceration and granulation tissue is elicited by 14 days of intubation by using the canine model of induced subglottic stenosis developed by Supance et al. [19]. When animals intubated for 14 days underwent an anterior cricoid split on day 7, the airway appears essentially normal by day 14. The split cricoid cartilage maintained a 'U' configuration following the procedure. The region of deficient cartilage anteriorly is bridged by fibrous tissue with normal epithelium lining the lumenal surface. Splitting the cricoid cartilage anteriorly increased the intralumenal area and no long term complications resulted from the procedure. The mechanisms by which the anterior cricoid split expands the airway intralumenal area while maintaining airway support have been reviewed.

Diagnosis and Treatment of Lesions of the Upper Airway: Part I: The Neonate

“…Since the original description, numerous investigators have reported their experiences utilizing this technique, with success rates ranging between 70 and 85%. 35 The term anterior laryngotracheal decompression was recently introduced by Cotton and associates 36 to describe more accurately the surgical technique cur-rently used. The goal of this procedure is to achieve extubation without resorting to tracheotomy.…”

“…The incidence of acquired subglottic stenosis following prolonged intubation in infants is currently reported at approximately 2%. 35 Up to 45% of NICU patients require prolonged nasotracheal intubation for periods longer than 7 days, 37 thus predisposing these infants to subglottic stenosis. The histopathologic features of this entity have been described elsewhere.…”

Expansion of the infant subglottis by external cricoid distraction: An animal model

“…Although experimental work in dogs has suggested that ACS may allow the cricoid to spring open or be actively distracted by the action of the intrinsic laryngeal muscles, 10.1 I postmortem histologic examination of the larynx in three children who died after ACS was unsuccessful in showing any significant separation at the site of the cricoid split.! ":" It therefore appears likely that the use of ACS …”