Modified single-stage segmental cricotracheal resection

Abstract

The objective of our work is to demonstrate in a large cohort of patients with cricotracheal stenosis that resection of long airway segments could be performed with no increased risk of postoperative complications. A consecutive series of patients getting cervical segmental cricotracheal resection (CTR) were reviewed. The typical segmental tracheal resection technique has been modified to accommodate long segment removal. Modifications include using trachea to enable the reconstruction of the larynx itself as well as the placement of a “laryngosternopexy” stitch between the thyroid lamina and the sternoclavicular ligament designed to take all of the tension off the anastomosis and to prevent inadvertent head extension. Anastomosis was performed by using continuous barbed sutures that allowed gradual approximation of the proximal and distal segments even in the presence of a large segmental airway resection defect that could involve as much as half of the tracheal length. Thirty-eight patients were treated. Primary etiologies of cricotracheal stenosis were prolonged intubation and tracheostomy. All had Grade III–IV stenosis. Only one patient had postoperative revision surgery for anastomosis-based disease. All patients with tracheostomy (n = 29) were successfully decannulated. Complications occurred in five patients. These included acute airway obstruction requiring emergency tracheostomy through the anastomosis, a tracheal dehiscence, laryngeal edema with airway obstruction, superficial wound infections, neck abscesses, and transient vocal cord immobility. Modified cricotracheal resection has comparable results to traditional techniques and may offer advantages such as resection of long tracheal segments without any increase in the risk of post-anastomosis airway leak.