CRICOTRACHEAL ANASTOMOSIS FOR ASSISTED VENTILATION-INDUCED STENOSIS

Objective: To review the long-term results and our experience with cri cotracheal anastomosis via a cervical approach for assisted ventilatio n-induced stenosis. Design: A case series of 41 patients consecutively treated with cricotracheal anastomosis. Setting: A tertiary care cent er and university teaching hospital. Patients: Group 1 consisted of 22 patients with stenosis reaching the lower border of the cricoid carti lage that did not require resection of the cricoid cartilage. Group 2 consisted of 19 patients in whom correction of the stenosis required c ricoid resection. Main Outcome Measures: Statistical analysis of airwa y patency was based on the Kaplan-Meier actuarial life table method. I ncidence for the various postoperative complications was presented. Un ivariate analysis was performed to analyze the relationships between v arious factors, airway patency, and the incidence for the various comp lications encountered. Results: The Kaplan-Meier 5-year airway patency estimate was 100% in group 1 patients and 82.5% in group 2 patients. In group 2 patients, complementary treatment with dilatations in 2 pat ients resulted in an overall 94.8% airway patency rate. In the last pa tient, the airway patency was not reestablished after cricotracheal an astomosis, and a Montgomery T tube was inserted. Postoperative complic ations included unilateral inferior laryngeal nerve paralysis (3 patie nts), cervical neck abscess (2 patients), pneumothorax (1 patient), an d major subcutaneous emphysema (1 patient). None of the following vari ables was statistically related to the airway patency or to the variou s complications encountered: sex, age, cause for stenosis, delay from initial injury, prior treatment, presence of a tracheotomy, number of tracheal rings resected, type of sutures used, and type of anastomosis performed. Conclusions: The data reported reemphasized that cricotrac heal anastomosis with or without cricoid resection is a safe and relia ble procedure for assisted ventilation-induced upper tracheal stenosis reaching and/or involving the subglottis and/or cricoid cartilage.