A modified technique of laryngotracheal reconstruction without the need for prolonged postoperative stenting

Repair of laryngotracheal stenosis with pronounced side-to-side narrowing and involvement of the glottis is challenging and usually requires laryngotracheal reconstruction with rib cartilage interpositions. This technique, as first described by Couraud, needs prolonged postoperative stabilization with Montgomery T-tubes, imposing significant morbidity and discomfort on patients. We describe our initial experience with a modified laryngotracheal reconstruction technique that avoids the need for prolonged postoperative stenting.

From November 2012 through May 2015, a series of 5 adult patients with glottosubglottic stenosis were operated in our institution. All patients had pronounced scar formation in combination with advanced side-to-side narrowing extending up to the level of the vocal folds. Operative technique consisted of a complete anterior and posterior laryngeal split followed by rib cartilage interposition in the cricoid plate posteriorly to enlarge the glottosubglottic diameter. The lateral edges of the rib graft were trimmed in such a way that lateral flanges were created, which allowed stable positioning of the graft. The distal trachea was then slid into the larynx, and the posterior defect was completely covered with a liberal membranous flap. The anterior part of the larynx was enlarged with a V-shaped segment of the anterior tracheal wall.

This technique provided immediate stability without the need for temporary endoluminal stenting. The perioperative course was uneventful in all patients, and functional outcome was excellent.

We conclude that this modified technique of laryngotracheal reconstruction represents a valid treatment option for patients with complex glottosubglottic stenosis, avoiding the need for prolonged postoperative stenting.