Background/Objectives: Idiopathic subglottic stenosis (iSGS) is a fibrotic disease characterized by upper airway obstruction, predominantly in female patients. Initial surgical management typically includes endoscopic procedures. Some patients require open airway reconstruction, which traditionally involves at least anterior resection of the cricoid cartilage. As an alternative to cricotracheal resection, we present a novel technique: cricoid-sparing high tracheal resection with excision of subglottic stenotic tissue from below.
Methods: Description of surgical technique as well as a single institution, single surgeon retrospective chart review.
Results: 41 patients underwent tracheal resection by the senior author from January 1, 2016 to December 30, 2020. 36 patients had iSGS and were included in this study. 100% were female. After mean follow-up time of over 2 years, none required tracheostomy. A novel set of posterior, circumferential cricoid sutures made for efficient and safe relining of the exposed cricoid plate. One patient had permanent, unilateral, vocal cord paralysis, but declined further compensatory treatment.
Conclusion: Cricoid-sparing high tracheal resection is a safe and durable alternative to cricotracheal resection for iSGS. The cricoid cartilage and cricothyroid muscles are left undisturbed, potentially decreasing the risk of postoperative dysphonia, namely lowered fundamental frequency. This is especially meaningful in the setting of a predominantly female patient population. Surgical innovations served to make this technique a safe and efficient way of treating iSGS.