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J Thorac Cardiovasc Surg 2009;137:573-579
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Tailored cricoplasty: An improved modification for reconstruction in subglottic tracheal stenosis

Division of Thoracic Surgery, Massachusetts General Hospital, Harvard School of Medicine, Boston, Mass

Received for publication May 8, 2008; revisions received October 21, 2008; accepted for publication November 16, 2008.

^_* Address for reprints: Douglas J. Mathisen, MD, 55 Fruit St, Blake 1570, Boston, MA 01748. (Email: dmathisen{at}partners.org).

Objective: Subglottic laryngotracheal stenosis with side-to-side narrowing poses a challenge for successful reconstruction. The standard technique of anterior cricoid resection was modified to address a small ventricle with lateral narrowing.

Methods: This study was a retrospective chart review and telephone questionnaire follow-up of consecutive patients with subglottic stenosis at a single institution. Follow-up questionnaires used Likert scales (ratings 1–10) to describe preoperative and postoperative symptoms, satisfaction, and perceived effectiveness. Once the anterior cricoid is removed, resection of thickened submucosal tissue is performed. The inner third to half of the lateral wall of the remaining cricoid cartilage is carefully excised. Advancing the preserved mucosa over the cricoid resurfaces the exposed cartilage. This results in additional horizontal enlargement of the luminal diameter of the airway of 3 to 5 mm.

Results: Eighteen patients with subglottic stenosis, small laryngeal ventricle, and lateral narrowing underwent tailored cricoplasty during a 15-month period. Mean age was 51 years (range 20–75 years), and mean follow-up was 9.1 ± 1.2 months (range 2–17 months). There were 2 self-limited airway complications. All patients reported that they were satisfied and would undergo surgery again. Overall satisfaction was rated at 9.5 ± 1.0, and satisfactions with resting and exertional dyspnea were 9.7 ± 0.5 and 9.5 ± 1.0, respectively. Symptoms of recurrence at follow-up were rated as 0.6 ± 1.4.

Conclusion: Tailored cricoplasty is an effective technique to improve the outcome of reconstructive subglottic stenosis. It offers reconstructive possibilities for patients with diminished side-to-side dimensions in the subglottic airway.