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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

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.

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