Laryngeal split and rib cartilage interpositional grafting: Treatment option for glottic/subglottic stenosis in adults

Objectives Severe glottic/subglottic stenosis (complex laryngotracheal stenosis) is a rare but challenging complication of endotracheal intubation. Laryngotracheal reconstruction with cartilage graft and an intralaryngeal stent is a procedure described for complex laryngotracheal stenosis management...

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Published in:The Journal of thoracic and cardiovascular surgery 2009-04, Vol.137 (4), p.818-823
Main Authors: Terra, Ricardo Mingarini, MD, Minamoto, Hélio, MD, Carneiro, Felipe, MD, Pego–Fernandes, Paulo Manuel, MD, Jatene, Fábio Biscegli, MD
Format: Article
Language:English
Subjects:
Adolescent
Adult
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cardiology. Vascular system
Cardiothoracic Surgery
Cartilage - transplantation
Female
Humans
Intubation, Intratracheal - adverse effects
Laryngostenosis - surgery
Male
Medical sciences
Middle Aged
Pneumology
Retrospective Studies
Ribs - transplantation
Young Adult
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Summary:Objectives Severe glottic/subglottic stenosis (complex laryngotracheal stenosis) is a rare but challenging complication of endotracheal intubation. Laryngotracheal reconstruction with cartilage graft and an intralaryngeal stent is a procedure described for complex laryngotracheal stenosis management in children; however, for adults, few options remain. Our aim was to analyze the results of laryngotracheal reconstruction as a treatment for complex laryngotracheal stenosis in adults, considering postoperative and long-term outcome. Methods Laryngotracheal reconstruction (laryngeal split with anterior and posterior interposition of a rib cartilage graft) has been used in our institution to manage glottic/subglottic stenosis restricted to the larynx; laryngotracheal reconstruction associated with cricotracheal resection has been used to treat glottic/subglottic/upper tracheal stenosis (extending beyond the second tracheal ring). A retrospective study was conducted, including all patients with complex laryngotracheal stenosis treated surgically in our institution from January of 2002 until December of 2005. Results Twenty patients (10 male and 10 female patients; average age, 36.13 years; age range, 18–54 years) were included. There were no deaths, and the postoperative complications were as follows: dysphonia, 25%; subcutaneous emphysema, 10%; tracheocutaneous fistula, 20%; wound infection, 15%; and bleeding, 5.0%. Eighty percent of the patients were completely decannulated after a mean of 23.4 months of follow-up (range, 4–55 months). Conclusions Laryngeal split with anterior and posterior cartilage graft interposition as an isolated procedure or associated with a cricotracheal resection is a feasible and low-morbidity alternative for complex laryngotracheal stenosis treatment.
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2008.08.035