Objective: To describe a new open procedure for management of combined glottic and subglottic stenosis.
Background: An increase in combined glottic and subglottic stenosis was noted during the COVID-19 pandemic. In adults, prior approaches using cricoid cartilage grafting and stenting often results in graft loss and granulation tissue. We describe Expansion Laryngoplasty (EL) for this difficult problem. It combines unilateral arytenoidectomy, posterior cricoid cartilage graft, and pyriform sinus advancement flap for composite tissue reconstruction of laryngeal stenosis.
Material and Method: Under general tracheal anesthesia, the larynx is accessed by anterior midline laryngofissure. The stenosis is opened by anterior and posterior cricoid split. The posterior glottis stenosis is lysed through cutting the posterior commissure. One fixed arytenoid is removed by submucosal resection by cutting through the crico-arytenoid joint. Hard tissue expansion is done by insertion of costal cartilage graft to the posterior and anterior cricoid. The posterior cartilage graft site is covered completely by an advancement pyriform sinus flap from the side of the arytenoidectomy. A standard Montgomery Stent is placed for 10 days.
Results: Good lumen expansion with mucosal coverage at the glottis and subglottis can be expected using EL. Eight of eleven patients treated have been decannulated. The other three are tracheotomy dependent due to tracheal stenosis. Three of the patients had prior failed LTR using other approaches.
Conclusion: Expansion Laryngoplasty (EL) combines cricoid expansion, unilateral arytenoidectomy and pyriform sinus advancement flap. It may be considered in surgical treatment of patients with combined glottic and subglottis stenosis.