Laryngotracheal Reconstruction for Moderate and Severe Subglottic Stenosis

Objective: To assess applicability of laryngotracheal reconstruction (LTR) with costal cartilage graft (CCG) in the management of moderate and severe subglottic stenosis.Methods: This prospective study was performed on 9 patients with moderate and severe subglottic stenosis between April 2005 and July 2008. Of these 9 patients, 6 (66.7%) had stenosis due to prolonged intubations for cardio-respiratory resuscitation, 2 (22.2%) had laryngoscleroma and one (11.1%) had laryngeal trauma. Three (33.3%) patients had grade II stenosis, 5 (55.6%) had grade III stenosis and one (11.1%) had grade IV stenosis. Three (33.3%) of the 9 patients under¬went laryngotracheal reconstruction (LTR) with anterior costal cartilage graft (CCG) only and 6 (66.7%) underwent laryn-gotracheal reconstruction (LTR) with anterior and posterior costal cartilage grafts (CCG).Results: Seven (77.8%) out of 9 patients were decannulated and maintained a symptom-free airway, while 2 (22.2%) patients had recurrent stenosis. Of the 7 decannulated patients, 6 had excellent results and one had good results (the caliber was slightly narrow causing mild respiratory discomfort during exercise). Postoperative complications included: temporary deglutition dysfunction (3 patients); superficial wound infection (one patient); anastomotic granulation tissue (two patients) and stent dislocation (one patient).Conclusion: Laryngotracheal reconstruction (LTR) with costal cartilage graft (CCG) is a safe and effective technique for the treatment of moderate and severe subglottic stenosis.