The subglottic space refers to the portion of the airway between the vocal cords and the inferior border of the cricoid cartilage. Attention to surgical pathology in this area was overshadowed for many years by the advent of successful surgery for strictures and neoplasms in the rest of the trachea. Surgical forays into this anatomic area was restricted to trauma and the management of neoplasms, wherein the ablative procedure resulted in significant impairment in glottic function. With the introduction of compliant cuffs on endotracheal tubes, the incidence of cuff strictures after endotracheal intubation decreased significantly. In addition, there has been an increasing tendency to maintain oral or nasal endotracheal intubation for longer periods of time before reverting to tracheotomy. Although more prolonged endotracheal intubation has not been causally linked to subglottic stenosis, the latter appears to have increased in incidence over the last 15 years. Before 1974, resection of the subglottic area involved the sacrifice of the recurrent laryngeal nerves because surgeons performed standard sleeve resections of the airway even in this high position. In order to resect higher into the subglottic compartment, Dr D.P. Bryce described the resection of the anterior arch of the cricoid, sparing the posterior plate and, thus, preserving the recurrent laryngeal nerves.’ It is, however, at the level of the posterior cricoid plate that the greatest degree of scarring is noted secondary to endotracheal intubation. Because of the curvature of the endotracheal tube, it’s point of maximal contact and pressure with the tracheal mucosa is the posterior cricoid plate. In order to overcome this difficulty, Dr F.G. Pearson described subperichondrial resection of the posterior plate in order to permit removal of the scar and at the same time preserve the recurrent nerves. la The understanding of this technique is dependent on a thorough appreciation of the anatomy of the area. Before considering surgical technique, it is important to understand the alternatives to surgical therapy based on the type of stricture. Fibrous strictures in the subglottic region are either inflammatory, idiopathic, or iatrogenic. Inflammatory strictures are most commonly seen with Wegener’s granulomatosis and less commonly with amyloid and collagenosis. It may respond to dilation and drug therapy, but in the later fibrous stage it will usually require resection. Idiopathic strictures occur primarily in middle-aged women2 and may respond to simple dilation. Its recurrence beyond two or three tracheal dilatations suggests that surgical intervention should be considered.2.K It is the iatrogenic stricture secondary to endotracheal intubation that accounts for the majority of stenoses. This too may respond to dilatation andlor stenting in the early stages, but by the time a fibrous stricture has occurred, surgical therapy is the rule. Laser therapy has been described in the past. However it is the experience of the investigators that it offers little over simple dilation and may indeed prolong the period of inflammatory change. Certainly, it is rarely definitive therapy for fibrous subglottic strictures, which frequently are associated with chondritis and calcification of the cricoid cartilage. Under these circumstances, laser therapy cannot be expected to provide lasting improvement and indeed may increase the magnitude of the injury if there is failure to control the depth of coagulation. The use of silastic stents bears particular mention. In patients who present contraindications to surgical resection, a silastic “T” tube provides a stable airway. The upper limb of the tube is positioned above the vocal cords. In this position, the patient maintains voice and the ability to swallow without aspiration.* In cases of acute subglottic injury, it may provide definitive therapy if positioned before the establishment of a mature scar.