The anterior cricoid split explored via the canine model, preliminary studies

Area of Science:

• Pediatric Surgery
• Otolaryngology
• Veterinary Medicine

Background:

• The anterior cricoid split, introduced in 1980, is a surgical technique used for difficult-to-extubate infants and children.
• The precise biomechanical effects of this procedure on the cricoid cartilage remain poorly understood.
• Understanding these effects is crucial for optimizing treatment strategies for pediatric airway obstruction.

Purpose of the Study:

• To investigate the impact of the anterior cricoid split on the cricoid cartilage structure.
• To evaluate the role of endotracheal tube stenting in modifying the effects of the procedure.
• To provide insights into the mechanics of the anterior cricoid split in a preclinical model.

Main Methods:

• The study utilized a canine model (Australian Shepherd puppies) divided into three groups: anterior cricoid split with stenting, anterior cricoid split without stenting, and a control group.
• A modified surgical technique allowed for endotracheal tube placement and maintenance while permitting normal activity in the subjects.
• All animals were sacrificed at 12 weeks of age for post-mortem analysis of the cricoid cartilage.

Main Results:

• A distinct gap was observed in the cricoid cartilage of all animals that underwent the anterior cricoid split procedure.
• The presence of an endotracheal tube stent significantly exacerbated the widening of this cricoid cartilage gap.
• These findings indicate a measurable structural alteration of the cricoid cartilage post-procedure.

Conclusions:

• The anterior cricoid split procedure demonstrably creates a gap in the canine cricoid cartilage.
• Endotracheal tube stenting further increases the size of this gap, suggesting a method to augment the subglottic space.
• This study provides evidence that the anterior cricoid split, particularly with stenting, can be a viable technique for increasing subglottic dimensions in a canine model.