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The anterior cricoid split. Clinical experience with extended indications
A F Drake1, J W Babyak, J K Niparko
1Department of Otolaryngology, University of Michigan Medical Center, Ann Arbor.
Archives of Otolaryngology--Head & Neck Surgery
|December 1, 1988
Summary
The anterior cricoid split (ACS) procedure effectively manages infant subglottic stenosis, relieving stridor and avoiding tracheotomy in most cases. This technique expands the airway, proving beneficial for extubation difficulties in neonates and pediatric patients.
Area of Science:
- Pediatric Otolaryngology
- Neonatal Critical Care
- Airway Management
Background:
- Subglottic stenosis in infants often results from subglottic edema postextubation.
- Traditional management may involve tracheotomy, which carries associated risks.
- The anterior cricoid split (ACS) procedure offers a less invasive alternative.
Purpose of the Study:
- To evaluate the efficacy of the anterior cricoid split (ACS) procedure in managing postextubation subglottic stenosis in infants.
- To assess the success rate of ACS in relieving stridor and avoiding tracheotomy.
- To explore the application of ACS in both neonatal and pediatric populations.
Main Methods:
- The anterior cricoid split (ACS) procedure was applied to manage extubation difficulty in pediatric and neonatal patients.
- Patient selection criteria were assessed, noting that five of ten patients did not meet traditional ACS criteria.
- Outcomes including stridor relief and need for tracheotomy were recorded.
Main Results:
- The ACS procedure successfully relieved stridor and avoided tracheotomy in nine out of ten patients.
- One patient required reinstitution of mechanical ventilation due to a complication.
- The procedure was effective even in some infants not meeting traditional ACS criteria.
Conclusions:
- The anterior cricoid split (ACS) is an effective adjunct for facilitating extubation in properly selected infants with subglottic airway compromise.
- The technique provides airway expansion with minimal dissection and avoids the need for tracheotomy in most cases.
- Further research may refine patient selection for optimal ACS outcomes.