The management of subglottic laryngeal stenosis by resection and direct anastomosis

The causes and relative incidence of stenosis in the trachea and subglottis are described. The special difficulties encountered in the subglottic region are discussed and references made to various treatments described in the past. An operation designed to produce a one‐stage cure with preservation of vocal cord function is described in detail. This consists of exposure of the laryngo‐tracheal complex and examination of the lesions directly. If suitable for excision, the upper line of resection is made at the lower border of the thyroid cartilage anteriorly and through the posterior cricoid lamina below the crico‐thyroid joints posteriorly. This is carried out only after identifying the recurrent laryngeal nerves on each side and tracing them up to the crico‐thyroid joints. Anastomosis of upper trachea to the remaining larynx is performed after mobilizing the two ends. At the upper end, this is achieved by the laryngeal drop procedure previously described by Bryce (1972). A stent may be inserted if the anastomosis requires support. A check suture preventing neck extension is not considered necessary. Postoperatively, a tracheostomy is maintained until the danger of aspiration has passed or until a stent is removed three weeks later. Naso‐gastric feeding is required for the first few days. Four case histories are presented. Pre‐operative radiographic assessment has been found to be misleading in most cases and the final decision on the procedure can be determined only at the time of surgery.