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Anterior cricoid split procedure with transposition of cricoid cartilage segment

  • J K Cho (a1), M H Ko (a1), J Ryu (a2) and H-S Jeong (a1)

Abstract

Objective:

In order to improve the outcome and to reduce the post-operative care burden following the anterior cricoid split procedure, we modified the procedure to involve splitting only the cricoid cartilage, not the mucosa deep to the cartilage. In addition, we transposed the cricoid cartilage segment after division of the cricoid ring in the midline.

Case report:

We present the use of our modification in a 19-month-old boy with early-stage subglottic stenosis.

Results:

The technique was performed in one surgical field, and the graft material obtained had the same thickness as the cricoid cartilage. Because there was no intraluminal break, this procedure allowed the patient to avoid the complications of prolonged stenting, and resulted in more rapid extubation.

Conclusion:

The anterior cricoid split procedure with transposition of the cricoid cartilage segment may be a useful treatment option for early-stage subglottic stenosis, with improved outcomes and a reduced post-operative care burden.

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Copyright

Corresponding author

Address for correspondence: Dr Han-Sin Jeong, Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ir-Won Dong, Kang-Nam Gu, Seoul, 135-710, South Korea. Fax: 82 2 3410 6987, E-mail: hansin.jeong@samsung.com

References

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1 Rethi, A. An operation for cicatricial stenosis of the larynx. J Laryngol Otol 1956;70:283–93
2 Cotton, RT. Prevention and management of laryngeal stenosis in infants and children. J Pediatr Surg 1985;20:845–51
3 Cotton, RT, Seid, AB. Management of the extubation problem in the premature child. Anterior cricoid split as an alternative to tracheotomy. Ann Otol Rhinol Laryngol 1980;89:508–11
4 Anderson, GJ, Tom, LW, Wetmore, RF, Handler, SD, Potsic, WP. The anterior cricoid split: the Children's Hospital of Philadelphia experience. Int J Pediatr Otorhinolaryngol 1988;16:31–8
5 Holinger, LD, Stankiewicz, JA, Livingston, GL. Anterior cricoid split: the Chicago experience with an alternative to tracheotomy. Laryngoscope 1987;97:1924
6 Eze, NN, Wyatt, ME, Hartley, BE. The role of the anterior cricoid split in facilitating extubation in infants. Int J Pediatr Otorhinolaryngol 2005;69:843–6
7 Grundfast, KM, Coffman, AC, Milmoe, G. Anterior cricoid split: a “simple” surgical procedure and a potentially complicated care problem. Ann Otol Rhinol Laryngol 1985;94:445–9
8 de Jong, AL, Park, AH, Raveh, E, Schwartz, MR, Forte, V. Comparison of thyroid, auricular, and costal cartilage donor sites for laryngotracheal reconstruction in an animal model. Arch Otolaryngol Head Neck Surg 2000;126:4953
9 Park, AH, Forte, V. Effect of harvesting autogenous laryngeal cartilage for laryngotracheal reconstruction on laryngeal growth and support. Laryngoscope 1999;109:307–11
10 Fayoux, P, Vachin, F, Merrot, O, Bernheim, N. Thyroid alar cartilage graft in paediatric laryngotracheal reconstruction. Int J Pediatr Otorhinolaryngol 2006;70:717–24
11 Forte, V, Chang, MB, Papsin, BC. Thyroid ala cartilage reconstruction in neonatal subglottic stenosis as a replacement for the anterior cricoid split. Int J Pediatr Otorhinolaryngol 2001;59:181–6

Keywords

Anterior cricoid split procedure with transposition of cricoid cartilage segment

  • J K Cho (a1), M H Ko (a1), J Ryu (a2) and H-S Jeong (a1)

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