The use of buccal mucosa graft at posterior cricoid splitting for subglottic stenosis repair

Background: Since 1955, when RUM established the posterior cricoid split au gmentation (PCSA) method, several authors have published supporting reports of the validity and proven efficacy of its basic principles. A 27-year pro spective, retrospective study. Objectives. To report on experience in perfo rming the PCSA method for subglottic and/or posterior-glottic stenosis repa ir using buccal mucosa interposition grafting at posterior cricoid split an d stenting for 8 weeks, and to assess the impact on vocal function. Methods : From 1972 on, 60 patients (45 adults, 15 children, aged 8 mo to 72 y) wit h subglottic and/or posterior-glottic stenosis were operated on using a mod ified PCSA method. The surgical technique consisted of posterior cricoid sp litting, including or not the interarytenoid muscle; wide lateral retractio n of the posterior cricoid halves; buccal mucosa interposition grafting and stenting for 8 weeks. The factors evaluated included the subglottic remode ling rate, donor and recipient sites morbidity, time to decannulation, rate of graft take, and phonatory function tests. Results: The modified PCSA pr ocedure resulted in a decannulation rate of 90%, 18 (30%) of which had furt her procedure to achieve decannulation, and 6 adult patients (10%) were con sidered failures because of restenosis. The rate of take of the mucosa graf t was 100% in both children and adults, with complete epithelialization of the grafted area, the mucosa not becoming dry and crusty. No interarytenoid muscle division resulted in near-normal to normal glottic voicing. Interar ytenoid muscle division determined supraglottic voicing with inspiratory no ise and pneumophonic incoordination, breathy and hoarse voice, low fundamen tal frequency, limited dynamic range, and shortened phonation time. Conclus ion: The PCSA procedure with buccal mucosa graft is reliable, safe, and hig hly successful with respect to the graft incorporation and subglottic remod eling. The division or not of the interarytenoid muscle is the most importa nt factor influencing the postoperative vocal function.