Laryngeal Release Research Articles

Swallowing outcomes after tracheal resection and anastomosis: full versus mini infrahyoid laryngeal drop

IntroductionTracheal resection anastomosis has been established as the definitive surgery for high grade postintubation subglottic stenosis. To achieve a relaxed tension-free anastomosis, various laryngeal release techniques were discussed in literature with potential effect on postoperative swallowing dysfunction. This study aims to compare the difference in swallowing outcomes following two methods of infrahyoid laryngeal release: with and without fracture of the superior thyroid horns.MethodsA retrospective cohort study was carried out at our tertiary referral hospitals including cases with grade III and IV subglottic stenosis treated by partial crico-tracheal resection with thyro-tracheal anastomosis. The patients were divided into two groups according to the method used in laryngeal release; mini infrahyoid release (group A) or infrahyoid full release (group B) where full means with fracture of the superior thyroid horn bilaterally while mini means their preservation. Swallowing assessment preoperatively and postoperatively was done by comparing swallowing dysfunction symptoms, Gugging swallowing screen (GUSS) score and fiberoptic endoscopic evaluation of swallowing (FEES) according to penetration aspiration scale (PAS).ResultsA total of 71 patients were included; 46 in Group A and 25 in Group B. Clinical swallowing evaluation one week postoperatively showed statistically significant difference between the two groups being affected in 80.04% and 100% of patients in group A and B, respectively. The mean postoperative GUSS were 18 ± 1.32 in group A patients in comparison to 8.84 ± 5.18 in group B (p-value < 0.001). With FEES assessment, group A had full improvement of their swallowing abilities one month after the surgery while patients in group B had significantly lower PAS scores. Unfavourable scores for both the GUSS test and PAS were associated with increasing patients’ age in group B.ConclusionIn this retrospective cohort study, cases with mini infrahyoid laryngeal release had significantly better swallowing outcomes and full resolution of dysphagia in comparison to full laryngeal release. Also, full laryngeal release is associated with delayed resolution of swallowing difficulty in older patients. This point should be considered during preoperative patient selection and counselling.

Sleeve resection with end-to-end anastomosis in the reconstruction of tracheal defects exceeding six rings: a clinical feasibility study and safety assessment.

Reconstruction is always required for tracheal defects and sleeve resection with end-to-end anastomosis is the most common used. The aim of the study was to present surgical techniques and evaluate the outcomes of sleeve resection with end-to-end anastomosis in the reconstruction of tracheal defects exceeding six rings. The study included patients with primary or secondary malignancies and tracheal stenosis from 2014 to 2019, who were treated with sleeve resection exceeding six tracheal rings, and reconstructed with end-to-end anastomosis. Airway status and patient outcomes were the principal follow-up measures. A total of 16 patients were enrolled in the study including three primary tracheal malignancies, 12 invasive thyroid carcinomas and one with tracheal stenosis. The extent of tracheal resection ranged from seven to nine rings, and the primary end-to-end anastomosis was performed in all 16 patients. Performance of tracheostomy or cricothyroidotomy was done in 6 patients with decannulation at a median of 42 days (range, 28-56). No anastomotic dehiscence, infection or bleeding occurred postoperatively, and all 16 patients maintained an unobstructed airway through the end of follow-up. Sleeve resection reconstructed with end-to-end anastomosis can serve as an appropriate therapeutic strategy for the tracheal defects even exceeding six rings. Adequate laryngeal release is the key to surgical success.

Outcome of congenital tracheal stenosis in children over two decades in a national cardiothoracic surgical unit.

To assess the outcomes of congenital tracheal stenosis among children. A retrospective review of all children who underwent surgical repair of congenital tracheal stenosis reviewing charts, operative notes, echocardiograms, CT and MRI data from January 2002 to February 2019. Twenty-six children underwent surgical treatment for tracheal stenosis. The median age was 3 months (range 0.3-35 months) and the median weight was 4.7 kg (range 2.5-13 kg) at the time of surgical intervention. Stridor was the most common presenting symptom in 17 patients (65% of patients). Twenty-one patients (81%) had concurrent cardiac anomalies, with pulmonary arterial sling being the most common, present in nine patients (34%). Extracorporeal life support was utilised in seven patients (27%) pre-operatively. Laryngeal release was required in 16 patients. In 7 patients an end-to-end anastomosis was performed, in 18 patients slide tracheoplasty, and 1 patient had a double slide tracheoplasty. The median cardiopulmonary bypass time was 106 minutes (range 25-255 minutes). The median cross-clamp time was 30 minutes (range 5-67 minutes). The median post-operative duration of ventilation was 5 days (range 0.5-16 days). The median ICU length of stay was 12.5 days (range 2-60 days). There were three hospital mortalities with 88% survival. One patient only required reintervention with balloon dilation. Twenty-two patients (85%) remained symptom-free on median follow-up at 7.6 years (range 0.2-17 years). Two patients since 2017 had 3D printed tracheas produced from CT imaging to assist surgical planning. Congenital tracheal stenosis can be managed effectively with excellent outcomes and 3D printed models assist in planning the optimal surgical intervention.

AB005. Complications and management following tracheal resection and reconstruction

AB005. Complications and management following tracheal resection and reconstruction

Postintubation Tracheal Stenosis: Management and Results 1993 to 2017

To evaluate the management, complications of treatment, and outcomes of postintubation tracheal stenosis. A retrospective review was performed of records from a prospective database of all patients undergoing tracheal or laryngotracheal resection from 1993 to 2017 for postintubation tracheal stenosis. Redo operations after failure of initial resection and reconstruction for postintubation tracheal stenosis were included. There were 392 patients whose ages ranged from 3 months to more than 84 years. A tracheostomy was performed in 275 as part of their care before surgery (present at time of resection in 123), dilations in 201, laser treatment in 82, T tubes in 66, and stents in 44 patients. Median length of resection was 3 cm. Laryngeal release was required in 15 of 392 (3.8%). Operative mortality was 0.8% (3 of 392); T tubes, tracheostomy present at resection, requirement for postoperative tracheostomy, and laryngeal involvement adversely impacted outcomes. Patients having tracheal resection and reconstruction had good or satisfactory outcomes in 96% (289 of 301) compared with 85% (77 of 91) having laryngotracheal resection. Complications within 30 days and at more than 30 days occurred in 116 patients and 14 patients, respectively. There were 96 anastomotic complications-68% minor (65 of 96), and 32% major (31 of 96). Necrosis of cartilage occurred in 12 patients and dehiscence in 14 patients. Despite advances in care postintubation tracheal stenosis remains a challenging problem. Laryngotracheal resection and tracheostomy lead to worse outcomes. Excellent surgical results can be obtained for postintubation tracheal stenosis. Good results require careful evaluation, management of comorbid conditions, meticulous technique, minimizing tension, and preservation of blood supply.

Outcome after long-segment tracheal resection: study of 52 cases.

Resection of long-segment trachea is challenging, and although 50% of adult trachea can be removed, anastomotic complications arise proportionally. Different release manoeuvres have been described to gain length and reduce tension at the suture line. The aim of the study was to evaluate the outcome when different release manoeuvres have been utilized during resection and reconstruction of the trachea. From January 2005 to December 2015, 52 patients with long segments of trachea ≥40 mm requiring resection and reconstruction were treated at our institute. Demographic, operative and postoperative data were retrospectively analysed. Fifty-two patients with long-segment tracheal disorders ≥40 mm were analysed in this stud. Transient swallowing and phonation dysfunction occurred in 17 (32.2%) patients, exclusively in patients who underwent laryngeal release. Swallowing dysfunction was Grade I in all patients, except 2 who suffered Grade II dysphagia and were relieved in the early postoperative period. Forty-five (86.5%) patients were symptom free, and 7 (13.4%) patients were symptomatic (dyspnoea on exertion and/or stridor) and required reintervention. Four (7.6%) patients responded to 1 or 2 sessions of bronchoscopic dilatation, and 3 patients were left with permanent tracheostomies. Patients with neoplastic pathology were followed up without any neoplastic recurrence. Long-segment resection and reconstruction of the trachea utilizing one or more release manoeuvres can be safely done, with low complication rates. Although swallowing and phonation dysfunction after laryngeal release were commonly encountered (almost one-third of patients), they were mild, transient, self-limited and recovered within 2-3 weeks of the early postoperative period.

AB002. Tracheal surgery

AB002. Tracheal surgery

Laryngeal release with slide tracheoplasty for long-segment congenital tracheal stenosis

Slide tracheoplasty is a standard treatment for long-segment congenital tracheal stenosis (LCTS). However, in severe cases of LCTS, aggressive divisions of inferior constrictor muscle from the thyroid cartilage and extensive circumferential dissection of the upper tracheal segment are often necessary to mobilize the upper tracheal segment enough to make an anastomosis, but they increase the risks of anastomotic dehiscence, recurrent nerve injury, and impaired deglutition. Alternatively, laryngeal release provides safe mobilization of the upper tracheal segment, minimizing dissection of the inferior constrictor muscle and preserving the lateral tissue pedicle without circumferential dissection. We successfully performed laryngeal release with slide tracheoplasty on six patients with severe LCTS, and report our findings.

Outcome of surgery for laryngotracheal stenosis in grade III and IV subglottic stenosis

Methods Thirteen patients with laryngotracheal stenosis were treated. Ten were males and 3 females with an age range of 4–60 years .The cause of airway stenosis was prolong intubation in 10, blunt trauma injury and idiopathic subglottic stenosis in 2 and 1consequence. Preoperative assessment included bronchoscopy, neck and chest CT scan to determine the extension of stenosis. The upper margin of the stricture was 3 mm to 1.0 cm. below the vocal cords; the stenotic segment extended from 3 to 6 cm. All patients except one had tracheostomy for a long period. Two patients had failed previous resections. In 10 patients dilatation and insertion of Montgomery T tube was the initial procedure. Pearson’s technique was used for laryngotracheal resection. Suprahyoid laryngeal release was performed in 8. Montgomery T tube were placed in 12 and left in place for 1 year.

Malignant Immature Teratoma of the Larynx and Trachea with Functional Osteocutaneous Free Flap Reconstruction

Malignant Immature Teratoma of the Larynx and Trachea with Functional Osteocutaneous Free Flap Reconstruction

Le signal acoustique de la déglutition pharyngée : description chez les sujets normaux et chez les patients laryngectomisés

Objectives Recently, we described three sound components in the pharyngeal swallowing sound. The aim of the present study was to identify the origin of these components using modern techniques providing numeric, synchronized acoustic-radiological data in a normal population and in a partial supracricoid laryngectomized population (SCL group) and a total laryngectomized (TL group) population in pre- and postoperative situations. Patients and methods We enrolled 15 normal subjects (10 men and five women; mean age, 29.5 ± 8 years), 11 patients in the SCL group (11 men; mean age, 62; range, 45–75 years), and nine patients in the TL group (three women, six men; mean age, 56; range, 39–73). An X-ray camera was connected to a video acquisition card to obtain acoustic-radiological data (25 images/s). The microphone was attached to each subject's skin overlying the lateral border of the cricoid. The subjects were asked to swallow 10 ml of a barium suspension. We performed the acoustic-radiological analysis using Visualisation and Cool Edit Pro software. Each sound component was associated with a specific position of the bolus and the moving anatomic structure. Three sound components were identified: the laryngeal ascension sound (LAS), the upper sphincter opening sound (USOS), and the laryngeal release sound (LRS). We quantified the total duration of the pharyngeal sound and its components, as well as the duration of the interval. Results The average duration of the normal pharyngeal sound was 690 ± 162 ms and was significantly decreased in the TL group (296 ± 105 ms) and increased in the SCL group (701 ± 186 ms). The USOS was present in 100% of the recordings. A typical profile of the swallowing sound for each group was obtained. Conclusion This study allowed us to determine the origin of the three main sound components of the pharyngeal swallowing sound with respect to movements in anatomic structures and the different positions of the bolus, and to describe the main variations induced by a partial and a total laryngectomy.

Origin of the Sound Components During Pharyngeal Swallowing in Normal Subjects

The aim of this study was to identify the origin of swallowing sound components by using modern techniques that can provide numeric, synchronized acoustic-radiologic data. We enrolled 15 volunteer subjects (10 men and 5 women, average age = 29.5 +/- 8 years) and used an X-ray camera connected to a video acquisition card to obtain synchronized acoustic-radiologic data (25 images/s). The subjects were asked to swallow 10 ml of a barium suspension. Each sound component was associated with a specific position of the bolus and the anatomic structure that was moving. The average duration of the pharyngeal sound was 690 +/- 162 ms. The durations of the laryngeal ascension sound and the laryngeal release sound were significantly different (72 +/- 38 ms and 106 +/- 47 ms, p < 0.001). The upper-sphincter opening sound was present in 100% of the recordings. Its duration was 185 +/- 103 ms and was significantly different from the two other sounds. The duration of the first interval was 108 +/- 44 ms and the duration of the second was 236 +/- 139 ms. This study allowed us to determine the origin of the three main sound components of the pharyngeal swallowing sound with respect to movements in anatomic structures and the different bolus positions.

Estenosis laringotraqueales: Resección y reconstrucción primaria

A review is made of patients with stenosis involving the larynx and trachea, treated in the thoracic surgery service of the Hospital de San Jose with resection and reconstruction techniques with primary anastomosis, during the period between 1996 and 2005. The histories were reviewed Clinical data and the information collected retrospectively were recorded in a database with: sex, age, origin, cause of the stenosis, location, severity, length, previous interventions related to the current problem, history of intubation, cause and duration of the same, time elapsed between extubation and the appearance of stenosis, stay in the ICU, history of tracheostomy, symptoms, management of acute airway obstruction, diagnostic images, endoscopic findings, surgical procedure performed, mortality, complications, time of hospitalization and functional results. Thirty patients, 16 men and 14 women were intervened. The age range varied between 12 and 80 years, with an average of 44. Twenty-seven patients had stenosis after intubation (25 orotracheal and 2 tracheostomy). The symptoms of obstruction occurred between 30 and 90 days after the procedure and the duration ranged between 3 and 45 days. In one patient an idiopathic stenosis was diagnosed, in another an inflammatory pseudotumor of the body of the trachea and in a third after trauma by firearm. In eight the narrowness compromised the laryngotracheal region, four in the subglottic space and four in the glottic in the posterior commissure. Seven of them secondary to orotracheal intubation and one idiopathic. In 22 patients it was located in the body of the trachea. The length of the narrow segment varied between 2 and 6 cm. The severity of the obstruction ranged between 70% and 90%. In two cases there was a combination of stenosis and tracheomalacia. The symptoms consisted of dyspnea of ​​effort and laryngeal stridor. There was acute obstruction of the airway in 18 and it was treated with tracheostomy in 16 and dilatations in two. Twelve patients had a tracheostomy tube when they visited the hospital. Three patients had undergone different procedures of resection and reconstruction in other institutions. In all cases, laryngeal and trachea CT and fibrobronchoscopy were performed. Three brought magnetic nuclear resonance at the time they were first evaluated in our service. Two patients were assessed in other institutions with linear tomography. In 14 patients with a clinical picture of airway obstruction, a volume flow curve was performed that showed a pattern of fixed obstruction of the upper airway. They were studied with arterial gases that showed mild to severe hypoxemia in ten and retention of CO in five. All the patients underwent resection and reconstruction by end-to-end anastomosis of the airway. In 26, a cervical approach was made and four required a combined cervical and sternal approach. In four patients with subglottic stenosis, resections were made of the anterior plate of the cartilage and the diseased mucosa, covering the defect with a membranous tracheal flap and anastomosis between the thyroid cartilage and the trachea. In one a tracheostomy cannula was left; in another, a plastic T tube was placed as a mold, which was maintained for seven months. The others were extubated at the end of the procedure. Four patients who presented lesions that compromised the glottis required a complex reconstruction consisting of a laryngofisura and resection of the entire anterior portion of the cricoid cartilage. In two, one T-tube was left for six months and in another a temporary tracheostomy cannula was placed. Twenty-two with stenosis of the body of the trachea were treated with resection and primary anastomosis of trachea segments whose length varied between 3 and 6 cm. Fifteen with resections larger than 3 cm required laryngeal release maneuvers. Three with stenosis greater than 5 cm required a median sternotomy for mobilization of the pulmonary hilum. In a patient with stenosis and tracheomalacia caused by compression by a goiter, the procedure was combined with a total thyroidectomy. One patient presented a new obstruction after the resection of a subglottic stenosis and was reoperated at six months. Hospitalization time varied between 8 and 20 days with an average of 9. There were two deaths due to tracheal fistulas with massive hemorrhage and seven complications in 30 resection and reconstruction procedures. The results obtained in 26 patients were excellent, with restoration of patency of the airway and recovery of the normal voice. To the extent that surgical reconstruction techniques have been perfected and experience with them is greater, We are increasingly convinced that resection and early reconstruction of these lesions is widely justified and that conservative treatment does not represent an appropriate alternative. Abbreviations: ICU, intensive care unit; CT scan, computerized axial tomography.

Surgical management of laryngotracheal stenosis in adults

The purpose was to evaluate the outcome following the surgical management of a consecutive series of 26 adult patients with laryngotracheal stenosis of varied etiologies in a tertiary care center. Of the 83 patients who underwent surgery for laryngotracheal stenosis in the Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Lausanne, Switzerland, between 1995 and 2003, 26 patients were adults (> or = 16 years) and formed the group that was the focus of this study. The stenosis involved the trachea (20), subglottis (1), subglottis and trachea (2), glottis and subglottis (1) and glottis, subglottis and trachea (2). The etiology of the stenosis was post-intubation injury ( n = 20), infiltration of the trachea by thyroid tumor ( n = 3), seeding from a laryngeal tumor at the site of the tracheostoma ( n = 1), idiopathic progressive subglottic stenosis ( n = 1) and external laryngeal trauma ( n = 1). Of the patients, 20 underwent tracheal resection and end-to-end anastomosis, and 5 patients had partial cricotracheal resection and thyrotracheal anastomosis. The length of resection varied from 1.5 to 6 cm, with a median length of 3.4 cm. Eighteen patients were extubated in the operating room, and six patients were extubated during a period of 12 to 72 h after surgery. Two patients were decannulated at 12 and 18 months, respectively. One patient, who developed anastomotic dehiscence 10 days after surgery, underwent revision surgery with a good outcome. On long-term outcome assessment, 15 patients achieved excellent results, 7 patients had a good result and 4 patients died of causes unrelated to surgery (mean follow-up period of 3.6 years). No patient showed evidence of restenosis. The excellent functional results of cricotracheal/tracheal resection and primary anastomosis in this series confirm the efficacy and reliability of this approach towards the management of laryngotracheal stenosis of varied etiologies. Similar to data in the literature, post-intubation injury was the leading cause of stenosis in our series. A resection length of up to 6 cm with laryngeal release procedures (when necessary) was found to be technically feasible.

An alternative method of neck flexion after tracheal resection

Tracheal resections for benign and malignant disease are well described. The addition of release procedures, including suprathyroid and suprahyoid laryngeal release, has increased the capability of extended tracheal resection and primary reconstruction. Constant neck flexion by a suture between the skin of the point of the chin and midline of the chest over the manubrium is also widely considered paramount to successful tracheal resections. We designed a straightforward alternative to this method for patient comfort and compliance.

Vocal violence in actors: An investigation into its acoustic consequences and the effects of hygienic laryngeal release training

Acoustic analysis techniques were used to investigate the short-term consequences of vocally violent behavior, and to compare voice production before and after training in hygienic laryngeal release (HLR) techniques. Twenty-seven actors ranging in age from 17 to 48 years were audiorecorded before and after multiple productions of 4 vocally violent behaviors: grunting, groaning, sobbing, and shouting. After training in HLR techniques, the experimental protocol was repeated. Audiorecordings of vowels (produced at 3 pitch levels: modal F0, minimum F0, maximum F0) before and after vocal violence, and before and after HLR training, were analyzed using the Multidimensional Voice Program (4305, Kay Elemetrics Corp, Lincoln Park, NJ). After vocal violence, no consistent acoustic changes were detected for voice generated at modal and minimum F0; however, significant increases in both fundamental frequency range and maximum F0 were observed. After training in HLR techniques, acoustic measures sensitive to pitch and amplitude perturbation, and non-harmonic noise, improved across pitch levels. The results also indicated that vocal training does defend the laryngeal system from undesirable changes related to vocally violent maneuvers that might surface at the extremes of an actor's pitch range. Because the HLR technique used in this investigation was multimodal, interesting questions are raised regarding which aspect of training is primarily responsible for the observed effects. Further study is required to identify such factors.

Reoperative tracheal resection and reconstruction for unsuccessful repair of postintubation stenosis

Objective: Our objective was to analyze characteristics and results of redo tracheal resection and reconstruction. Methods: Seventy-five patients were operated on between 1966 and 1997 after unsuccessful initial repairs for postintubation tracheal stenosis. Results: Sixteen of these patients came from a group of 32 patients with unsuccessful repair among the 450 primary resections and reconstructions performed at our institution. Fifty-nine patients were referred to us after unsuccessful initial repair elsewhere. Initial management was a T-tube or tracheotomy in 39 patients. The length of repeat resection ranged from 1.0 cm to 5.5 cm (mean 3.5 cm). A laryngeal release was used in 19 patients (25%) to reduce anastomotic tension. Complications occurred in 29 patients (39%) and were most frequent in the group requiring laryngeal release (12/19, 63.2%). Overall outcome was good in 59 patients (78.6%) and satisfactory in 10 (13.3%). The repair was unsuccessful in four patients (5.3%), and two patients died (2.6%). Conclusions: Despite difficulties encountered in reoperative surgery after failed tracheal reconstruction for postintubation stenosis, successful outcome may be achieved in a large number of cases. (J Thorac Cardiovasc Surg 1997;114:934-9)

Extensive tracheal resections and reconstruction

Tracheal sleeve resection and primary anastomosis are generally accepted as the methods of choice for tracheal repair. Malignant neoplasms, restenosis after surgery, and failure of conservative management (dilatation or stents) require extensive resection with additional surgical maneuvers to enable an anatomic end-to-end anastomosis. Since 1975, 33 patients underwent a extensive resection of one half or more of the trachea. There were 21 male and 12 female patients: mean age was 46.4 years (range 16 to 64 years). Rigid bronchoscopy, tracheography and computed tomography is used to specify the length of the stenosis, the distance from the vocal cords and, in cases of tumor, the extent and invasion of mediastinal structures. Besides the tracheal resection, suprahyoid laryngeal release (n = 13), pericardial incision and mobilization of the right lung hilus (n = 8), additionally mobilization of the left lung with division of Bottali ligament (n = 4), laryngeal release and hilus mobilization (n = 6), and division of the left main bronchus and reimplantation in the bronchus intermedius (n = 2) were used to reduce tension on the anastomosis. One postoperative death resulted from rupture of the innominate artery. Long-term results were excellent in 22 patients, good in 6, satisfactory in 3, and poor in 2. In our experience, extensive tracheal resection and reconstruction using different release procedures are safe with good long-term results.

Results and prognostic factors in resections of primary tracheal tumors: A multicenter retrospective study

To determine long-term survival and prognostic factors, 208 patients with primary tracheal tumors were evaluated in a retrospective multicenter study including 26 centers. Ninety-four patients had squamous cell carcinoma, four had adenocarcinoma, 65 had adenoid cystic carcinoma, and 45 patients had miscellaneous tumors. The following resections were performed: tracheal resection with primary anastomosis, 165; carinal resection, 24; and laryngotracheal resection, 19. Postoperative mortality rate was 10.5% and correlated with the length of the resection, the need for a laryngeal release, the type of resection, and the histologic type of the cancer. Fifty-nine percent of patients with tracheal cancer and 43% of patients with adenoid cystic carcinomas had postoperative radiotherapy. The 5- and 10-year survivals, respectively, were 73% and 57% for adenoid cystic carcinomas and 47% and 36% for tracheal cancers ( p < 0.05). Among patients with tracheal cancers, survival was significantly longer for those with complete resections than for those with incomplete resections. On the other hand, the presence of positive lymph nodes did not seem to decrease survival. Postoperative radiotherapy increased survival only in the case of incompletely resected tracheal cancers. Long-term prognosis was worsened by the occurence of second primary malignancies in patients with tracheal cancers and by the occurence of late pulmonary metastases in patients with adenoid cystic carcinomas. (J T HORAC C ARDIOVASC S URG 1996;111:808-14)

Postintubation tracheal stenosis: Treatment and results

A total of 503 patients underwent 521 tracheal resections and reconstructions for postintubation stenosis from 1965 through 1992. Fifty-three had had prior attempts at surgical resection, 51 others had undergone various forms of tracheal or laryngeal repair, and 45 had had laser treatment. There were 251 cuff lesions, 178 stomal lesions, 38 at both levels, and 36 of indeterminate origin. Sixty-two patients with major laryngeal injuries required complete resection of anterior cricoid cartilage and anastomosis of trachea to thyroid cartilage, and 117 had tracheal anastomosis to the cricoid. A cervical approach was used in 350, cervicomediastinal in 145, and transthoracic in 8. Length of resection was 1.0 to 7.5 cm. Forty-nine had laryngeal release to reduce anastomotic tension. A total of 471 patients (93.7%) had good (87.5%) or satisfactory (6.2%) results. Eighteen of 37 whose operation failed underwent a second reconstruction. Eighteen required postoperative tracheostomy or T-tube insertion for extensive or multilevel disease. Twelve died (2.4%). The most common complication, suture line granulations (9.7%), has almost vanished with the use of absorbable sutures. Wound infection occurred in 15 (3%) and glottic dysfunction in 11 (2.2%). Five had postoperative innominate artery hemorrhage. Resection and reconstruction offer optimal treatment for postintubation tracheal stenosis. (J T HORACC ARDIOVASC S URG 1995;109:486-93)