Arytenoid prolapse as a consequence of cricotracheal resection in children

Cricotracheal resection (CTR) is a technique introduced comparatively recen tly for treating severe laryngotracheal stenosis in children. The recognize d complications of CTR include recurrent laryngeal nerve damage, anastomoti c dehiscence, and restenosis. We describe a further complication of CTR, na mely, prolapse of the arytenoid cartilage. The presentation may be late, wi th symptoms of shortness of breath on exertion and nocturnal stertor with a poor sleep pattern, or the prolapse may be an asymptomatic incidental find ing. The diagnosis is performed with flexible nasopharyngoscopy with the pa tient unanesthetized, or with rigid endoscopy with the patient lightly anes thetized and spontaneously ventilating. The affected arytenoid cartilage is noted to prolapse anteriorly and medially with inspiration, partly obstruc ting the airway. If treatment is required, endoscopic laser partial aryteno idectomy is effective. In a series of 44 children who underwent CTR, 20 wer e noted to develop arytenoid prolapse after operation. Twelve were asymptom atic, and 8 required laser arytenoidectomy, 2 of whom now require continuou s positive airway pressure for moderate supraglottic collapse.