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Technically this operation can be classified into two different methods: the anastomosis of the upper trachea to cricoid cartilage, and to the remaining larynx after partial resection of cricoid cartilage. While the former is almost the same as the the end-to-end anastomosis of the trachea, the latter is different in the following ways: First, the resection of cricoid cartilage must be made at the lower border of the thyroid cartilage anteriorly and through the posterior cricoid lamina below the crico-thyroid joints posteriorly. This oblique resection line intends to prevent the injury of recurrent laryngeal nerve at the posterior crico-thyroid joint. Second, the cut surface at the level of anterior crico-thyroid joint is smaller than the tracheal lumen by 44% from luminal reconstruction by using silicon. This result indicates that the lumen of the trachea must be reduced for approximation to the remaining larynx after removal of cricoid cartilage. Eight cases of laryngotracheal stricture were successfully operated upon by end-to-end direct anastomosis between the larynx and the trachea. Four cases were operated upon, anastomosing the trachea to the remaining larynx resected cricoid cartilage partially. Among these, 3 had suffered from difficult decanulation after tracheotomy and 1 from endotracheal infiltration of thyroid cancer. Thus, this operation is suitable for subglottic stenosis originating from the lesion of the upper trachea. It is still an unsolved problem as to how far into the subglottic region is resectable. One case died from heart failure 3 months after operation and one from bleeding due to infiltration of thyroid cancer a month postoperatively. The remaining 6 were uneventful postoperatively and are now living normal life.

Reconstructive Surgery of the Airway: Operative Technique and Indication of Laryngotracheal Anastomosis