Tailored cricoplasty: an improved modification for reconstruction in subglottic tracheal stenosis

Area of Science:

• Otolaryngology
• Laryngology
• Surgical Innovation

Background:

• Subglottic laryngotracheal stenosis presents significant reconstructive challenges, particularly when associated with lateral narrowing.
• The standard anterior cricoid resection technique may be insufficient for cases involving a small laryngeal ventricle and diminished side-to-side airway dimensions.

Purpose of the Study:

• To evaluate the efficacy of a modified anterior cricoid resection technique, termed tailored cricoplasty, for subglottic stenosis with lateral narrowing.
• To assess patient outcomes, including symptom improvement and satisfaction, following this tailored surgical approach.

Main Methods:

• A retrospective chart review and telephone questionnaire follow-up of 18 consecutive patients who underwent tailored cricoplasty for subglottic stenosis.
• The technique involves excising the inner portion of the lateral cricoid wall and advancing preserved mucosa to enlarge the airway horizontally by 3-5 mm.

Main Results:

• Eighteen patients with subglottic stenosis and lateral narrowing underwent the procedure over 15 months.
• Mean follow-up was 9.1 months; all patients reported satisfaction (rated 9.5/10) and would undergo the surgery again, with minimal recurrence symptoms (0.6/1.4).
• Two self-limited airway complications occurred.

Conclusions:

• Tailored cricoplasty is an effective surgical technique for improving outcomes in patients with subglottic stenosis characterized by lateral narrowing.
• This approach expands reconstructive possibilities for challenging subglottic airway dimensions.