Cricotracheal Resection in Nontracheotomized Adults: A Prospective Case Series

Abstract

Cricotracheal resection is a modern technique of airway reconstruction used in cases of subglottic stenosis. We report a case series of adult, nontracheotomized patients. Fifteen patients with significant subglottic stenosis were identified as presenting with dyspnea and stridor. The stenosis was grade III in 14 cases and grade II in 1 case, according to the Cotton classification. The causes were manifold, with intubation and tracheostomy being the predominant risk factors. Cricotracheal resection was performed in all cases with preoperative and postoperative videotracheoscopy. The mean postoperative intubation time was 41.7 hours (11 to 103 hours), and the mean length of stay in the intensive care unit was 2.6 days (3 to 9 days). Videotracheoscopy for reassessment was performed after 96 days (average). In 13 of the 15 patients the subglottic lumen was returned to a normal diameter. In 1 case a recurrent stenosis was managed with repeated endoscopic interventions. One patient died on postoperative day 4 because of a pulmonary embolism. Additional complications consisted of 1 axillary venous embolism, 4 cases of ventilator-associated pneumonia, and 1 case of transient unilateral recurrent nerve palsy that recovered completely. Cricotracheal resection is a reliable and versatile technique for the reconstruction of the subglottic airway, almost regardless of the underlying cause. Most complications observed have not been associated directly with the procedure, but reflect the significant comorbidity of the patient population. There seems to be an increased risk for thromboembolic events that may be a consequence of the preoperative immobilization of dyspneic patients.