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Laryngotracheal resection and reconstruction for postintubation subglottic stenosis. Lessons learned

Laryngotracheal resection and reconstruction for postintubation subglottic stenosis. Lessons learned AbstractBetween 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. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cardio-Thoracic Surgery Oxford University Press

Laryngotracheal resection and reconstruction for postintubation subglottic stenosis. Lessons learned

European Journal of Cardio-Thoracic Surgery , Volume 7 (6) – Jun 1, 1993
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Publisher
Oxford University Press
Copyright
© 1993 Springer-Verlag
ISSN
1010-7940
eISSN
1873-734X
DOI
10.1016/1010-7940(93)90171-7
Publisher site
See Article on Publisher Site

Abstract

AbstractBetween 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.

Journal

European Journal of Cardio-Thoracic Surgery – Oxford University Press

Published: Jun 1, 1993

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