Laryngotracheal resection and reconstruction for postintubation subglottic stenosis. Lessons learned

Between 1981 and June 1992, 26 consecutive patients with a postintubation subglottic stenosis (21 circumferential, 2 anterolateral) underwent the Pearson operation. Subglottic stenosis resulted from a complication of mechanical ventilation with endotracheal intubation with (n = 14) or without (n = 12) tracheostomy (median placement: 25 days). One patient had an associated laryngopharyngeal and tracheoesophageal fistula. Overall, the upper limit of the stenoses lay 1.8 +/- 0.3 cm below the vocal cords, falling in the range of 1 to 2 cm in 88% of patients; they measured 2.9 +/- 0.8 cm in length and the diameter at the level of the maximum stenotic process was 0.5 +/- 0.1 cm. Operations were performed without dissection of the recurrent nerves and plicature of the membranous trachea. Because of scarred mucosa at a higher level, one vertical section of the posterior cricoid plate with interposition of autogenous costal cartilage and 2 subtotal cricoid plate resections with stenting were necessary. The mean length of resection was 3.6 +/- 0.8 cm (range: 2-5 cm) and 88% of them ranged within 2.8 and 5 cm. Twelve thyrohyoid and 3 supralaryngeal releases were performed. Six patients required postoperative tracheostomy, but all were extubated within 24 h. Good results were obtained in 24 (96%) surviving patients; 1 failure and 1 postoperative death (sudden myocardial infarction) occurred. The results confirm that the Pearson operation is an adequate treatment for subglottic stenosis extending up to 1 cm below the vocal cords and measuring up to 6 cm in length. Dissection of both the recurrent nerves, plicature of the membranous trachea, postoperative decompressive tracheostomy and stenting are not necessary.