Laryngeal stenosis after supracricoid partial laryngectomy

The purpose of this study was to review the incidence, risks, management, a nd outcomes of nontumoral laryngeal stenosis after supracricoid partial lar yngectomy (SCPL) in a case series of 376 consecutive SCPLs performed at 1 i nstitution from 1975 to 1995 with a minimum of 3 years of follow-up. Post-S CPL nontumoral symptomatic laryngeal stenosis was defined as an inability t o decannulate patients before the 60th postoperative day (group 1) or the d evelopment of dyspnea (in patients without local recurrence) after an initi al period of prolonged, successful decannulation (group 2). Of 376 SCPLs pe rformed, nontumoral symptomatic laryngeal stenosis developed in 14 (3.7%). There were 7 patients (1.85%) in group 1 and 7 patients (1.85%) in group 2. In univariate analysis, none of the following variables appeared to be sta tistically related to the risk of immediate stenosis (group 1): age, gender , comorbidity, diabetes mellitus, symptomatic gastroesophageal reflux, arte ritis, preoperative radiotherapy, arytenoid cartilage disarticulation, type of reconstruction performed, and postoperative radiotherapy. A delayed lar yngeal stenosis (group 2) was statistically more likely to occur if the rec onstruction performed at the time of SCPL was a cricohyoidopexy (p = .01). Successful management of the laryngeal stenosis without permanent tracheost omy was achieved in 5 group 1 patients and 3 group 2 patients. We believe t hat stenosis in group 1 patients arose through technical error, whereas gro up 2 patients seemed to suffer from problems of healing, mainly cicatricial narrowing of the airway at the site of the cricohyoidal impaction, or pexi s. As a result, whereas laryngeal stenosis in group 1 patients was usually more easily correctable through dilation, laser incision, or resection of r edundant tissue or revision of the impaction, laryngeal stenosis in soup 2 patients presented a more difficult and frustrating complication. The manag ement and outcomes of these patients are presented.