Partial cricoidectomy with primary thyrotracheal anastomosis for postintubation subglottic stenosis

Objective: We describe a Pearson-type technique and evaluate its results fo r postintubation subglottic stenosis, Methods: Forty-five patients underwent a partial cricoidectomy with primary thyrotracheal anastomosis, and 5 underwent simultaneous repair of a trache oesophageal fistula as well. Twenty-four (53%) patients were referred to us after initial conservative (n = 21) or operative (n = 3) management. There were 27 cuff lesions, 7 stomal lesions, and 11 at both levels. The upper l imit of the stenosis was 1.5 cm (range, 1-2.5 cm) below the cords, and the subglottic diameter was reduced by 60% in 38 (84%) of the patients. The len gth of airway resection ranged from 2 to 6 cm (median, 3 cm). Despite 23 th yrohyoid or suprahyoid releases, 8 anastomoses were under tension. Results: Thirty-seven (82%) patients were extubated after the operation (n = 30) or within 24 hours (n = 7). Six patients required postoperative airwa y stenting (median, 5.5 days). Early (<30 days) complications occurred in 1 8 (41%) patients, mainly as transient airway and voice complaints, aspirati on, and dysphagia. One (2%) patient died of myocardial infarction. Late mor bidities were 3 failures occurring as bilateral recurrent nerve paralysis a nd restenosis requiring definitive tracheostomy, Patients had excellent or good anatomic (n = 42 [96%]), functional (n = 41 [93%]), or both types of l ong-lasting results, with no stenotic relapse. Conclusions: Partial cricoidectomy with primary thyrotracheal anastomosis c an be applied in patients with postintubation stenosis extending up to 1 cm below the cords and measuring up to 6 cm in length with excellent-to-good definitive results. The association with a tracheoesophageal fistula does n ot contraindicate surgical repair.