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Abstract
In laryngeal expansion surgery for subglottic and tracheal stenosis, after vertically dividing the stenotic segment in the midline and insertion of graft material between the divided segments, either prolonged stenting with tracheostomy (4-6 weeks) or short-term stenting using endotracheal tube with sedation or mechanical ventilation (1-2 weeks) is required until the airway is stabilized. The postoperative period is far more difficult and requires meticulous skillful care. This experimental study was designed to explore the use of microplates and auricular cartilage graft in providing immediate airway stability and to determine the surgical outcome of this procedure. Subglottic stenosis was ceriated in 11 dogs using repeated abrasive technique to the mucosa and perichondrium. All 11 dogs underwent laryngotracheal reconstruction without intraoperative complications. Immediately after reconstruction, the airway diameter returned to the prestenotic diameter and was maintained till the end of this study 6 weeks postoperatively as measured by endotracheal tube sizing. Histological examination revealed complete epithelization over all the grafted regions except at small areas with minimal granulations in 4 dogs. Viable grafts were identified in 8 cases and 3 cases with insignificant necrosis. This study suggests that rigid distraction of the stenotic airway with microplates and auricular cartilage graft has a good surgical outcome. Allowing repair of the stenosis without stenting or tracheostomy and provides immediate airway stability. , the technique of using external fixation with microplates to provide immediate rigid external support and auricular cartilage graft promise to be very helpful in maintaining distraction of the divided anterior cricoid and upper tracheal segments obviating the need for tracheostomy or prolonged stenting.
The auricular cartilage is a useful grafting material for LTR because it closely resembles the strength and width of the tracheal cartilage and can be used effectively for a grade I or II stenosis. It has the advantage of having minimal donor site morbidity the auricular cartilage graft-in laryngotracheal reconstruction is more successful than the anterior cricoid split operation treating mild to moderate SGS we have had limited success with ACGs in grade III stenosis and are reluctant to use them in grade IV stenosis, staged reconstruction long-segment SGS, long-segment tracheal stenosis, or revision of a failed auricular or costal cartilage.