Laryngotracheal resection and reconstruction for postintubation subglottic stenosis *1Lessons learned

Publisher Website
Google Scholar
Abstract
Between 1981 and June 1992, 26 consecutive patients with apostintubation subglottic stenosis (21 circumferential, 2 anterolateral)underwent the Pearson operation. Subglottic stenosis resulted from acomplication of mechanical ventilation with endotracheal intubation with (n= 14) or without (n = 12) tracheostomy (median placement: 25 days). Onepatient had an associated laryngopharyngeal and tracheoesophageal fistula.Overall, the upper limit of the stenoses lay 1.8 +/- 0.3 cm below the vocalcords, falling in the range of 1 to 2 cm in 88% of patients; they measured2.9 +/- 0.8 cm in length and the diameter at the level of the maximumstenotic process was 0.5 +/- 0.1 cm. Operations were performed withoutdissection of the recurrent nerves and plicature of the membranous trachea.Because of scarred mucosa at a higher level, one vertical section of theposterior cricoid plate with interposition of autogenous costal cartilageand 2 subtotal cricoid plate resections with stenting were necessary. Themean length of resection was 3.6 +/- 0.8 cm (range: 2-5 cm) and 88% of themranged within 2.8 and 5 cm. Twelve thyrohyoid and 3 supralaryngeal releaseswere performed. Six patients required postoperative tracheostomy, but allwere extubated within 24 h. Good results were obtained in 24 (96%)surviving patients; 1 failure and 1 postoperative death (sudden myocardialinfarction) occurred. The results confirm that the Pearson operation is anadequate treatment for subglottic stenosis extending up to 1 cm below thevocal cords and measuring up to 6 cm in length. Dissection of both therecurrent nerves, plicature of the membranous trachea, postoperativedecompressive tracheostomy and stenting are not necessary.

This publication has 0 references indexed in Scilit: