Endoscopic laryngotracheoplasty (Maddern procedure) for idiopathic subglottic stenosis

Abstract

•Endoscopic laryngotracheoplasty (Maddern procedure) is a scarless and durable therapy for iSGS. •Maddern procedure avoids risks associated with cricotracheal resection. •Surgery includes endoscopic scar excision with placement of a split-thickness skin graft and stent. •Exclusion criteria are dense posterior scar, glottic involvement, and long segment stenosis. Endoscopic laryngotracheoplasty, also known as the “Maddern procedure,” is a definitive endoscopic treatment for subglottic stenosis via a scarless approach. This technique focuses on endoscopic resection of the subglottic mucosa and scar without disturbing the cartilaginous framework of the larynx and trachea. A split-thickness skin graft is then used to reline the tracheal lumen, in order to facilitate healing and avoid scar recurrence. The skin graft is held in place by a silastic stent. This article describes the surgical technique of endoscopic laryngotracheoplasty, as well as peri-operative considerations and possible complications. Endoscopic laryngotracheoplasty, also known as the “Maddern procedure,” is a definitive endoscopic treatment for subglottic stenosis via a scarless approach. This technique focuses on endoscopic resection of the subglottic mucosa and scar without disturbing the cartilaginous framework of the larynx and trachea. A split-thickness skin graft is then used to reline the tracheal lumen, in order to facilitate healing and avoid scar recurrence. The skin graft is held in place by a silastic stent. This article describes the surgical technique of endoscopic laryngotracheoplasty, as well as peri-operative considerations and possible complications.