LARYNGOTRACHEAL RESECTION AND RECONSTRUCTION FOR POSTINTUBATION SUBGLOTTIC STENOSIS - LESSONS LEARNED

Between 1981 and June 1992, 26 consecutive patients with a postintubat ion subglottic stenosis (21 circumferential, 2 anterolateral) underwen t the Pearson operation. Subglottic stenosis resulted from a complicat ion of mechanical ventilation with endotracheal intubation with (n = 1 4) or without (n = 12) tracheostomy (median placement: 25 days). One p atient had an associated laryngopharyngeal and tracheoesophageal fistu la. Overall, the upper limit of the stenoses lay 1.8 +/- 0.3 cm below the vocal cords, falling in the range of 1 to 2 cm in 88% of patients; they measured 2.9 +/- 0.8 cm in length and the diameter at the level of the maximum stenotic process was 0.5 +/- 0.1 cm. Operations were pe rformed without dissection of the recurrent nerves and plicature of th e membranous trachea. Because of scarred mucosa at a higher level, one vertical section of the posterior cricoid plate with interposition of autogenous costal cartilage and 2 subtotal cricoid plate resections w ith stenting were necessary. The mean length of resection was 3.6 +/- 0.8 cm (range: 2-5 cm) and 88% of them ranged within 2.8 and 5 cm. Twe lve thyrohyoid and 3 supralaryngeal releases were performed. Six patie nts required postoperative tracheostomy, but all were extubated within 24 h. Good results were obtained in 24 (96%) surviving patients; 1 fa ilure and 1 postoperative death (sudden myocardial infarction) occurre d. The results confirm that the Pearson operation is an adequate treat ment for subglottic stenosis extending up to 1 cm below the vocal cord s and measuring up to 6 cm in length. Dissection of both the recurrent nerves, plicature of the membranous trachea, postoperative decompress ive tracheostomy and stenting are not necessary.