Posterior cricoid split with costal cartilage augmentation for high subglottic stenosis

Background: Stenosis of the upper subglottis presents special problems. Its vicinity to the vocal folds leads to a high incidence of vocal fold fixation, and also precludes surgical treatment by cricotracheal resection and anastomosis

Objective: To describe the experience with posterior cricoid split and insertion of free costal cartilage graft in the treatment of high subglottic stenosis and posterior commissure glottic stenosis.

Setting: Tertiary care university hospital.

Methods: Four cases with Grade III/ IV high subglottic stenosis/ posterior commissure glottic webbing recalcitrant to previous surgical therapy treated with posterior cricoid split and insertion of free costal cartilage graft by a laryngo-fissure approach. Temporary airway stenting for 4 months post surgery with a silicone T-Tube.

Results: Successful restoration of the airway and decannulation in all 4 cases.

Conclusion: Grade III or IV stenosis of the upper half of the subglottis is successfully treated in a high proportion of patients with posterior cricoid split and augmentation with costal cartilage free graft.