Repair of chronic subglottic stenosis with autogenous thyroid cartilage

Chronic subglottic stenosis continues to be a difficult management problem. Conservative management with bougienage, laser therapy, mitomycin-C, and/or steroid injections frequently fails. Definitive resection of the subglottis with thyrotracheal anastomosis has increased in popularity, but carries significant operative risks and postoperative complications. In the past 9 years, we have used a modification of a technique to successfully widen the subglottis, which we previously published 20 years ago. By a laryngocricotracheofissure approach, the cricoid cartilage is split vertically, both anteriorly and posteriorly. Cartilage grafts, obtained from the upper thyroid laminae anteriorly, are inserted in these splits. The posterior graft is fixed in place with specially designed pins, which improves graft fixation by adding rigidity and shortens the procedure. The repair is held in place for 3 to 4 weeks with either a silicone T tube or a conforming laryngeal stent. The charts of 21 consecutive patients treated with open repair of chronic subglottic stenosis were reviewed. The overall decannulation rate was 95%. We conclude that autogenous grafting is a useful tool in the treatment of chronic subglottic stenosis. Posterior cartilage graft fixation with our pin technique offers a significant advantage over suture fixation by improving graft stability and decreasing operative time, and has a high rate of decannulation.