Anterior cricoid split, 1977-1987. Evolution of a technique

Acquired subglottic stenosis is a well-documented complication of endotracheal intubation in infants. In past years, many of these patients required a tracheotomy for a period of years prior to laryngotracheal reconstruction. The anterior cricoid split procedure was developed as a method of treatment for severe laryngeal stenosis in infants and young children without resorting to a tracheotomy. An analysis of our institution's ten-year experience with 67 patients is presented, detailing the changes in surgical technique that have taken place over that time period. This is contrasted with alternative means of cricoid decompression advocated by other surgeons. Our review supports the efficacy of this procedure when there is strict adherence to certain criteria prior to the performance of the operation. Specifically, this operation should be restricted to neonates or young infants whose pathology is limited to the glottis and subglottis or both, and in whom there is adequate pulmonary reserve.