posterior costochondral graft laryngoplasty

posterior glottic stenosis;
severe subglottic stenosis;
bilateral vocal cord paralysis

severe active airway inflammation or infection

endoscopic microlaryngoscopy equipment; 90 degree table turn; intraoperative tracheotomy airway

direct laryngoscopy and bronchscopy; rule out severe reflux or eosinophilic esophagitis; rule out active pulmonary disease

anterior larynx split from lower third of thyroid cartilage through the first/second tracheal ring in the midline. The anterior commissure is not divided. The cricothyroid muscles are left intact.
The graft is carved to fit the posterior split with a precise match. The width of the luminal face of the graft can vary from 3-6 mm. It is not necessary to suture the graft into place. After positioning the graft, patients are nasotracheally intubated for 7-10 days in cases of a single-stage approach or a suprastomal stent is positioned for 10-21 days in cases of a double-stage approach.

Advantages: precise positioning of graft. Tracheotomy can be avoided.
Disadvantages: Open approach. Must be careful to not violate the anterior commissure.

Short-term: Graft displacement/migration
Long-term: Arytenoid prolapse/subluxation

Short-term: Graft displacement/migration
Long-term: Arytenoid prolapse/subluxation

none

1: Rutter MJ, Cotton RT. The use of posterior cricoid grafting in managing
isolated posterior glottic stenosis in children. Arch Otolaryngol Head Neck Surg. 2004 Jun;130(6):737-9. PubMed PMID: 15210555.

2: Maresh A, Preciado DA, O'Connell AP, Zalzal GH. A comparative analysis of open surgery vs endoscopic balloon dilation for pediatric subglottic stenosis. JAMA Otolaryngol Head Neck Surg. 2014 Oct;140(10):901-5. doi: 10.1001/jamaoto.2014.1742. PubMed PMID: 25170960.

3: Preciado D. A randomized study of suprastomal stents in laryngotracheoplasty surgery for grade III subglottic stenosis in children. Laryngoscope. 2014
Jan;124(1):207-13. doi: 10.1002/lary.24141. Epub 2013 May 13. PubMed PMID: 23670810.