HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content

J Thorac Cardiovasc Surg 2009;137:578-579
© 2009 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr Erino A. Rendina (Rome, Italy). First, I congratulate you on an excellent experience. Eighteen tailored cricoplasties in 15 months is an outstanding experience, and the results are very good.

In your series, predictably, the vast majority of patients had idiopathic subglottic stenosis. These patients are the most difficult to treat, and they are notoriously vulnerable to recurrence. This type of stenosis is usually short, and although I concur with the prudential measure of keeping the patient's neck flexed for 1 week, as stated in the article, this entailed a lack of release maneuvers in your series. Despite the idiopathic nature of the stenosis, you did not have any remarkable complication or recurrence, and this is an exceptional achievement. The only postoperative problems arose from mucosal edema, which might be of particular severity at such a high airway location, as stated in your article.

I have three questions. First, your modification consists of enlarging the airspace laterally, whereas the classical repair, the Pearson repair, prescribes the posterior resection of the cricoid plate beneath the mucosa. How often were both enlargement techniques needed simultaneously to obtain an adequate airspace?

Dr Liberman. Thank you for your comments. In terms of getting the posterior cricoid plate exposed and removing thickened tissue, I don't have the exact numbers for this experience, but it's done approximately half the time. For most of these patients, as we said, the issue is that the stenosis is high and they have a severe side-to-side narrowing. The anteroposterior dimension is quite easy to fix. Once you remove the anterior portion of the cricoid, your anteroposterior dimension is improved. We have no hesitation in removing the posterior cricoid plate and resurfacing that, however, which is much simpler than fixing the side-to-side narrowing.

Dr Rendina. You stated that you extubate your . . . [Full Text of this Article]