Composite hyoid-sternohyoid interposition graft revisited: UCLA experience 1974-1984

The surgical correction of severe laryngotracheal stenosis remains a challenging problem. We report on a series of 20 patients treated with the composite hyoid-sternohyoid interposition graft (HSIG). They range in age from 1 to 66 years and all had severe subglottic stenosis refractory to dilatation and stenting procedures. The major cause of stenosis was prolonged endotracheal intubation (16/20); the majority of patients (13/20) had severe medical illness complicating their airway management. Postoperative results were judged on the basis of decannulation, voice strength, and quality as well as activity tolerance. Follow-up periods were over 24 months in all cases. Twelve patients were decannulated and three keep their tracheotomy tubes permanently plugged. All have socially acceptable voices and good activity tolerance. Seven patients who were aphonic had voice improvement. There were three complete failures; one secondary to infection, one due to severe scleroderma, and one because of graft displacement. Each patient underwent an average of four postoperative endoscopies for airway evaluation and removal of granulation tissue. CAT scanning was useful in diagnosing postoperative problems, especially graft displacement, which was impossible to diagnose by endoscopic examination. We conclude that the composite hyoid-sternohyoid interposition graft is a useful and reliable tool in the treatment of subglottic stenosis.