Thyrotracheal End-to-End Anastomosis for Severe Laryngotracheal Stenosis

Baek, Chung Hwan; Hong, Byung Soo; Chung, Young Jun; Jeong, Han Sin; Son, Young Ik

Abstract

BACKGROUND AND OBJECTIVES
Management of a severe (Cotton-Myer grade III &IV) laryngotracheal stenosis (LTS) between the subglottis and upper trachea is not easy. Resection of stenotic segments and anastomosis of the resected margins, i.e. thyrotracheal anastomosis (TTA), would be one of the most physiologic treatment options for severe LTS. However, this procedure is not widely popularized because of the fear of technical difficulties and/or associated dreadful complications. Authors aimed to analyze the treatment outcomes and related complications of TTA that we have recently experienced. MATERIALS AND METHOD: We retrospectively analyzed 9 cases with severe LTS, who were treated by TTA between May 1999 and August 2002. We reviewed the direct causes of LTS, pathologic findings of the resected specimens, early and delayed postoperative complications, and the success rate of TTA. RESULTS: Decannulation without significant aspiration was achieved in 8 cases (88.9%). A 3 year-old girl failed to be decannulated because of recurring scar tissues in the posterior cricoid. Several types of early complications occurred in 4 cases (44.4%);of these, 2 cases involved airway obstruction due to mucosal edema or redundant mucosa, 1 case involved wound infection, 1 case involved transient vocal cord palsy. Two cases (22.2%) experienced delayed granulation formation, which were endoscopically managed at 3-4 weeks after TTA. CONCLUSION: High-success and low-major complication rates warrant TTA as a relatively safe and useful treatment option for a severe LTS. To accomplish the better treatment outcome with TTA approach, viable mucosa must be secured at the resection margin, infection has to be minimized before the surgery, mucosa should be carefully handled to prevent postoperative edema or redundancy, and prolonged attention needs to be paid against a possible delayed granulation formation.