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J Thorac Cardiovasc Surg 2009;137:818-823
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Laryngeal split and rib cartilage interpositional grafting: Treatment option for glottic/subglottic stenosis in adults

Ricardo Mingarini Terra, MD*, Hélio Minamoto, MD, Felipe Carneiro, MD, Paulo Manuel Pego–Fernandes, MD, Fábio Biscegli Jatene, MD

Division of Thoracic Surgery, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil

Received for publication April 3, 2008; revisions received June 29, 2008; accepted for publication August 20, 2008.

* Address for reprints: Ricardo M. Terra, MD, Al. Fernao Cardim, 161 ap. 61–Jardim Paulista, CEP: 01403-020 São Paulo, Brazil. (Email: rmterra{at}uol.com.br).

Objectives: Severe glottic/subglottic stenosis (complex laryngotracheal stenosis) is a rare but challenging complication of endotracheal intubation. Laryngotracheal reconstruction with cartilage graft and an intralaryngeal stent is a procedure described for complex laryngotracheal stenosis management in children; however, for adults, few options remain. Our aim was to analyze the results of laryngotracheal reconstruction as a treatment for complex laryngotracheal stenosis in adults, considering postoperative and long-term outcome.

Methods: Laryngotracheal reconstruction (laryngeal split with anterior and posterior interposition of a rib cartilage graft) has been used in our institution to manage glottic/subglottic stenosis restricted to the larynx; laryngotracheal reconstruction associated with cricotracheal resection has been used to treat glottic/subglottic/upper tracheal stenosis (extending beyond the second tracheal ring). A retrospective study was conducted, including all patients with complex laryngotracheal stenosis treated surgically in our institution from January of 2002 until December of 2005.

Results: Twenty patients (10 male and 10 female patients; average age, 36.13 years; age range, 18–54 years) were included. There were no deaths, and the postoperative complications were as follows: dysphonia, 25%; subcutaneous emphysema, 10%; tracheocutaneous fistula, 20%; wound infection, 15%; and bleeding, 5.0%. Eighty percent of the patients were completely decannulated after a mean of 23.4 months of follow-up (range, 4–55 months).

Conclusions: Laryngeal split with anterior and posterior cartilage graft interposition as an isolated procedure or associated with a cricotracheal resection is a feasible and low-morbidity alternative for complex laryngotracheal stenosis treatment.

Abbreviations and Acronyms CT = computed tomographic; CTR = cricotracheal resection; LTS = laryngotracheal stenosis






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