Autologous Cricoid Cartilage as a Graft for Airway Reconstruction in an Emergent Technique - A Case Report

Izadi, Farzad; Vaghardoost, Reza; Derakhshandeh, Vita; Sobouti, Behnam; Ghavami, Yaser

doi:10.22038/ijorl.2016.6555

Autologous Cricoid Cartilage as a Graft for Airway Reconstruction in an Emergent Technique - A Case Report

Document Type : Case Report

Authors

¹ Department of Otorhinolaryngology, Iran University of Medical Sciences, Tehran, Iran.

² Department of Aesthetic and Reconstructive, Iran University of Medical Sciences, Tehran, Iran.

³ General Practitioners, Research Assistant, Iran University of Medical Sciences and Health Services, Tehran, Iran.

10.22038/ijorl.2016.6555

Abstract

Introduction:
Laryngotracheal stenosis can be caused after traumatic injuries to the neck from the subglottic larynx to the trachea. Patients with laryngotracheal stenosis often need a tracheotomy and occasionally may become tracheotomy dependent. Different procedures have been described for the management of these lesions. Management options include techniques of endoscopic dilation, laser resection, laryngo-fissure, and an innovative array of plastic reconstructions with or without the use of stents.

Case Report:
This paper presents airway reconstruction in a young patient with severe subglottic stenosis due to a blunt trauma to the neck, who was treated using particles of an autologous fractured cricoid cartilage as the source for airway augmentation. An incision was made in the anterior midline of the cricoid lamina and deepened through the scar tissue to the posterior cricoid lamina. Then two lateral incisions (right & left) were made in the cricoid lamina and fractured cartilage particles and the scar tissue were removed via these two lateral incisions. The mucosal lining at the right and left of the midline incision, after debulking, were sutured to a lateral position. Thereafter three cartilage particles were used to reconstruct the anterior cricoid lamina and augment the lumen.

Conclusion:
It is worth to mention that an autologus cartilage graft can be used for certain cases with traumatic airway stenosis. Further follow up and more patients are needed to approve this method of reconstructive surgery in emergent situations.

Keywords

References

1. Sandhu Guri, Nouraei SA Reza. Laryngeal and esophageal trauma. In: Flint PW, Haughey BH, Lund VJ, Niparko JK, Richardson MA, Robbins KT, et al. Cummings Otolaryngology, Head & Neck surgery. Philadelphia, PA: Elsevier; 2010: 933-42.

2. Pearson FG. Technique of management of subglottic stenosis. Chest Surg Clin Nam 1996; 6(4): 683-92.

3. Khalid Ayesha, Goldenberg D. Surgical Management of Upper Airway Stenosis. In: Flint PW, Haughey BH, Lund VJ, Niparko JK, Richardson MA, Robbins KT, et.al. Cummings Otolaryngology, Head and Neck surgery. Philadelphia, PA: Elsevier; 2010:943-52.

4. Alvarez-Buylla Blanco M, Vázquez Barro JC, González-Botas JH, Martínez Vidal J. Surgical treatment of subglottic stenosis. Acta Otorrinolaringol Esp 2010;61:282-6.

5. Abbasi dezfouli A, Akbarian E, Shadmehr MB, Arab M, Javaherzadeh M, Pejhan S, et.al. The etiological factors of recurrence after tracheal resection and reconstruction in post-intubation stenosis. Interact Cardiovasc Thorac Surg 2009; 9:446-9.

6. Rutter MJ, Cotton RT. The use of posterior cricoid grafting in managing isolated posterior glottic stenosis in children. Arch Otolaryngol Head Neck Surg 2004; 130:737-9.

7. Furák J, Szakács L, Nagy A, Rovó L. Multiple costal cartilage graft reconstruction for the treatment of a full-length laryngotracheal stenosis after an inhalation burn. Interact Cardiovasc Thorac Surg 2011; 13: 453-5.

8. Weber TR, Connors RH, Tracy TF Jr. Acquired tracheal stenosis in infants and children. J Thorac Cardiovasc Surg 1991; 102: 29-34.