Cricotracheal Resection for Subglottic Stenosis following Prior Dissection and Tracheostomy

Cricotracheal resection is a definitive treatment for subglottic tracheal stenosis. This procedure can be challenging in the redo setting.

A 32-year-old man was referred to our department with post-intubation subglottic tracheal stenosis related to diabetic ketoacidosis 5 years ago. The stenosis was approximately 80% starting 2 cm below the glottis. A tracheal resection was attempted in the same year, but resulted in a tracheostomy due to strong adhesions around the trachea. The patient was followed up while maintaining spontaneous breathing and phonation. However, he desired stoma closure and was scheduled for reoperation. The patient was intubated in the supine position through the existing tracheostomy, and an incision was made along the previous incision. The adhesions around the trachea were meticulously dissected. On the cephalic side, a longitudinal incision was made through the anterior wall of the scarred trachea while preserving the subglottic mucosa. The trachea was transected at the level of the existing tracheostomy, and the caudal end of the trachea was dissected and resected just below the tracheostomy. The mucosa was further dissected from the cricoid cartilage, and the anterior cricoid arch was resected. The stenosed mucosa was then resected. The posterior wall of the mucosa was sutured continuously with 4-0 polydioxanone, and the anterior wall was anastomosed with interrupted 3-0 polydioxanone under intermittent apnea. Ventilation was resumed with a laryngeal mask. A tracheostomy was placed 1.5 cm below the anastomosis. The patient was discharged on POD 19 without complications. The tracheostomy tube was removed 2 months after surgery, and bronchoscopy 3 months after surgery confirmed a wide patent anastomosis. At 8 months, he has normal phonation and swallowing.

This redo cricotracheal resection required meticulous dissection and a carefully planned ventilation strategy.