Anterior Cricoid Split, 1977-1987: Evolution of a Technique

Abstract

\s=b\Acquired subglottic stenosis is a well-documented complication of endotracheal intubation in infants. In past years, many of these patients required a tracheotomy for a period of years prior to laryngotracheal reconstruction. The anterior cricoid split procedure was developed as a method of treatment for severe laryngeal stenosis in infants and young children without resorting to a tracheotomy. An analysis of our institution's ten\x=req-\ year experience with 67 patients is presented, detailing the changes in surgical technique that have taken place over that time period. This is contrasted with alternative means of cricoid decompression advocated by other surgeons. Our review supports the efficacy of this procedure when there is strict adherence to certain criteria prior to the performance of the operation. Specifically, this operation should be restricted to neonates or young infants whose pathology is limited to the glottis and subglottis or both, and in whom there is adequate pulmonary reserve. (Arch Otolaryngol Head Neck Surg 1988;114:1300-1302 Si nce its development more than ten years ago,1 the anterior cricoid split procedure has undergone an evo¬ lution in terms of both the surgical technique and the population for whom the procedure is indicated. Our institution's experience with 67 patients who have undergone an ante¬ rior cricoid split procedure is reviewed, emphasizing the current indications, contraindications, and surgical techniques utilized.

Tailored cricoplasty: An improved modification for reconstruction in subglottic tracheal stenosis

“…These techniques range from endoluminal therapies to definitive surgical procedures. [1][2][3][4][5][6][7][8][9][10][11][12][13] Endoluminal therapies are palliative at best. Surgical resection of the abnormal tissue and reconstruction with healthy tissue is preferable and has been associated with good long-term results.…”

“…These have ranged from repeated laser resections and dilations, to resection and reconstruction, to cartilage interposition into the cricoid. 1,2,[5][6][7][8][9] The small laryngeal ventricle is a combination of increased submucosal thickening and narrowed side-to-side or lateral dimensions of the cricoid cartilage. Conventional techniques do not address these findings.…”

“…Subjectively reported symptoms before and after cricoplasty (Likert scale[1][2][3][4][5][6][7][8][9][10] …”

Failed Extubation of a Double-lumen Tube Requiring a Cricoid Split

“…Cricoid split is a procedure most commonly used to improve the patency of the upper airways of infants who develop subglottic stenosis following prolonged tracheal intubation 21 . We are unaware of any previous cases where such a procedure has been required to facilitate the removal of an endotracheal tube.…”

Laryngotracheal Reconstruction without Stenting

“…During the past 10 years, the treatment of subglottic stenosis has evolved to use more restrained surgical procedures and shorter stenting periods. The anterior cricoid split was introduced in the early 1980s in an effort to prevent the progression of subglottic stenosis and to avoid the complications of a tracheostomy in children 3–8. Many other reports have substantiated this approach.…”