Posterior cricoid plate drill enlargement in idiopathic subglottic stenosis

Idiopathic subglottic stenosis (ISS) is an airway stricture between larynx and trachea, within 1 cm from the vocal cords. Resection-reconstruction present technical issues because of the need to resect the anterior portion of the cricoid cartilage, but not the posterior plate beyond which the recurrent laryngeal nerves access the vocal cords. The main surgical challenge consists of the minute airway calibre short below the cords, ensuing after the resection. We propose drill posterior cricoid plate moulding to obtain antero-posterior and lateral amplification of the laryngo-tracheal anastomosis.

This is a retrospective study of patients who underwent laryngo-tracheal resection with drill enlargement between January 2023 and June 2024. Laryngo-tracheal resection was performed according to Pearson's technique. At this point, airway calibre is gauged by endotracheal tubes of increasing size. To enlarge the air space, the inner surface of the posterior plate was moulded by drill. Breathing, complications, voice and swallowing function were recorded.

Our study includes 23 consecutive patients with ISS. No mortality was described. Fifteen patients (65.2%) described voice alteration and 7 (30.4%) experienced transient swallowing impairment. The mean operative time was 94.56 (±28.72) min. All patients breathed well at discharge. Overall early success rate was excellent (no sequelae) in 7 (30.4%) patients, and good (grade A: voice/breathing changes not influencing the quality of life; grade B: abnormal voice and shortness of breath, not hindering normal activities) in 15 (65.2%). At the mean follow-up of 10.5 ± 5.5 months, definitive success was achieved.

This is the first study describing this technique. The results of our early experience with drill moulding of the posterior cricoid plate are promising. It is an innovative, simple, safe, and effective method for subglottic airway enlargement in ISS, resulting in low post-operative complications, and in good to excellent results.