A Case of Subglottic Stenosis Treated with Resection of the Cricoid Cartilage and Circumcision of a Tracheal Ring

AbstractIn neonates, acquired subglottic stenosis (SGS) is the most serious long term complication of endotracheal intubation. In this case report, we describe the pathological changes in the larynx of a child who died two years after successful treatment, involving corrective surgery, for neonatally acquired SGS. Stenosis, due to dense fibrous connective tissue, was still present at death. However, there was evidence that there had been growth of the laryngeal cartilages. Disruption of the laryngeal cartilages was present anteriorly due to the antecedent surgery but major cricoid cartilage injury secondary to intubation was not seen. The crico-arytenoid joints demonstrated ankylosis and to this was attributed the abnormal quality of voice noted in the child at follow-up. The pathological changes are considered in relation to the pathology of endotracheal intubation and pathogenesis of acquired subglottic stenosis.

Download Full-text

Histopathology of Acquired Subglottic Stenosis

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948109000409 ◽

1981 ◽

Vol 90 (4) ◽

pp. 335-338 ◽

Cited By ~ 5

Author(s):

Gabriel F. Tucker ◽

Leonard Newton ◽

Robert J. Ruben

Keyword(s):

Endotracheal Tube ◽

Horizontal Plane ◽

Cricoid Cartilage ◽

Subglottic Stenosis ◽

Total Occlusion ◽

History Of ◽

The Right ◽

Stenotic Area

The history of a 2,900 g infant who had no stridor at birth and developed subglottic stenosis is presented in detail. The laryngeal lumen, which accepted a 3 mm endotracheal tube at one day of age, diminished to total occlusion at 15 months of age. There was an 8-day intubation and tracheotomy at nine months. At 19 months the patient expired from associated cardiac problems; the larynx was obtained at autopsy and was serially sectioned in the horizontal plane. A series (1mm-Tracer) of 12 sections through the stenotic area is presented. It demonstrates gross distortion of the cricoid cartilage with ossification extending into the right paraglottic larynx.

Download Full-text

Experimental Animal Model of Subglottic Stenosis

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947708600620 ◽

1977 ◽

Vol 86 (6) ◽

pp. 835-840 ◽

Cited By ~ 45

Author(s):

Bernard Borowiecki ◽

Charles B. Croft

Keyword(s):

Animal Model ◽

Pilot Study ◽

Experimental Animal ◽

Cricoid Cartilage ◽

Subglottic Stenosis ◽

Experimental Animal Model ◽

Show Evidence

An animal model of subglottic stenosis has been developed. The results of this pilot study show evidence to suggest that injury to the cricoid cartilage leading to perichondritis is the important factor in the development of subglottic stenosis.

Download Full-text

Laryngeal Chondrosarcoma as a Rare Cause of Subglottic Stenosis

Case Reports in Otolaryngology ◽

10.1155/2014/730643 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Kerem Kökoğlu ◽

Özlem Canöz ◽

Serap Doğan ◽

Emrah Gülmez ◽

İmdat Yüce ◽

...

Keyword(s):

Physical Examination ◽

Distant Metastasis ◽

Cricoid Cartilage ◽

Surgical Excision ◽

Subglottic Stenosis ◽

Rare Entity ◽

Intact Mucosa

Laryngeal chondrosarcoma (CS) is a very rare entity. It is usually seen in 50–80-year olds. It is developed from cricoid cartilage largely. Patients have laryngeal CS complaint of respiratuvar distress, dysphonia, and dysphagia generally. A submucous mass is usually seen in physical examination with an intact mucosa. Distant metastasis is rare in CSs. Main treatment is surgical excision. An 82-year-old patient who has respiratuvar distress is presented in this paper and laryngeal CS is reviewed in the light of the literature.

Download Full-text

DOZ047.72: Three-dimensional printing for preoperative planning of open laryngotracheal surgery

Diseases of the Esophagus ◽

10.1093/dote/doz047.72 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

G Fishman ◽

O Wasserzug ◽

P Berman ◽

E Golden ◽

A DeRow

Keyword(s):

3D Printing ◽

Preoperative Planning ◽

Medical Center ◽

Cricoid Cartilage ◽

Three Dimensional ◽

Balloon Dilation ◽

3D Models ◽

Subglottic Stenosis ◽

Preliminary Results

Abstract Background Three-dimensional (3D) printing is being employed in a variety of surgical specialties to improve patient care. These models enable preoperative in vitro planning, advanced resident training, and better patient education. 3D models of the tracheobronchial tree that can simulate bronchoscopy and 3D printed cricoid cartilage models for balloon dilation training have been reported. A 3D model for preoperative planning of open laryngotracheal surgery has not been reported. Objectives The objective of this study was to report preliminary results with the employment of 3D printing technology for preoperative planning of laryngotracheoplasty (LTP) and cricotracheal resection (CTR). Materials and Methods Actual-size 3D models of the upper airway, from the level of the base of tongue to the level of the carina, have been created by the surgical 3D printing lab in the medical center. The models were based on computed tomography of two patients who were scheduled for LTP and CTR. The models were composed of several elements: the framework of the larynx and the trachea, the air column, the cannula, and the peri-stomal region. Results Two models were created, a model of a patient with grade III subglottic stenosis who subsequently underwent LTP and a model of a patient with grade IV subglottic stenosis who subsequently underwent CTR and end to end anastomosis. The 3D models were found to be useful for preoperative planning of the incision site in the trachea, the status of the tracheal and laryngeal framework, the length of the diseased segment, and the length of the rib cartilage graft to be harvested. Conclusions The preliminary results of this study imply that 3D models can be useful for preoperative planning of open laryngotracheal surgery. Further experience is required to establish its efficacy, the optimal model design, and cost effectiveness.

Download Full-text

Malformed cricoid cartilage causing congenital subglottic stenosis: A rare case report

Trends in Anaesthesia and Critical Care ◽

10.1016/j.tacc.2020.10.005 ◽

2020 ◽

Author(s):

Michelle Shirin Lazar ◽

Ajay Singh ◽

Babita Ghai ◽

Rajeev Chauhan

Keyword(s):

Case Report ◽

Rare Case ◽

Cricoid Cartilage ◽

Subglottic Stenosis ◽

Rare Case Report

Download Full-text

Morphometric analysis of human cricoid cartilage: a cadaveric study

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20175054 ◽

2017 ◽

Vol 4 (1) ◽

pp. 63 ◽

Cited By ~ 1

Author(s):

Viswanathan Anand ◽

Harikesh Sharma ◽

Ashwani Sethi ◽

Satyanjaya Sahoo

Keyword(s):

Morphometric Analysis ◽

Cricoid Cartilage ◽

Thyroid Cartilage ◽

Upper Airway ◽

Vocal Folds ◽

Subglottic Stenosis ◽

Detailed Knowledge ◽

Transverse Diameter ◽

Average Height ◽

Health Care Centre

Background: Cricoid cartilage is the only complete ring that surrounds the airway completely. Although it is smaller than thyroid cartilage and does not house any important structures like the thyroid cartilage (vocal folds), it forms an important cog in the upper airway. Renewed interest in subglottic stenosis recently has underscored the importance of detailed knowledge of cricoid cartilage. This study aims to augment the meagre information available on this important part of upper airway. Methods: Study design was on morphometric analysis and the setting was at tertiary health care centre. Thirty one adult human cadaveric larynges were obtained for this study. Using an electronic vernier caliper, different morphometric parameters of all the cricoid cartilages were noted down in a predesigned proforma in standard computer office software. The data thus obtained was collated and compared with existing literature. Results: The average inner transverse diameter (F: 15.05±1.02 mm; M: 17.52±2.64 mm) is greater than the average inner antero-posterior diameter (F: 12.71±0.45 mm; M: 14.11±2.55 mm). The average height of cricoid arch was F: 6.50±0.68 mm; M: 7.69±0.63 mm and the average height of cricoid lamina was F: 18.38±0.61 mm; M: 21.17±2.31 mm. Conclusions: Inter specimen disparity was noted in the various dimensions measured in the cricoid cartilages. The average transverse diameter was greater than the average antero-posterior diameter giving the cartilage an ovoid shape in nearly all specimens. Morphometrical data of the cricoid cartilage may be very useful in endotracheal intubation, laryngeal microsurgery and laryngeal framework surgery. These parameters can be helpful in evaluation of subglottic stenosis and its surgical repair.

Download Full-text

Rib Cartilage Grafts for the Treatment of Posterior Glottic and Subglottic Stenosis in Children

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948809700513 ◽

1988 ◽

Vol 97 (5) ◽

pp. 506-511 ◽

Cited By ~ 46

Author(s):

George H. Zalzal

Keyword(s):

Surgical Treatment ◽

Endotracheal Intubation ◽

Exercise Tolerance ◽

Cricoid Cartilage ◽

Voice Quality ◽

Subglottic Stenosis ◽

Cartilage Graft ◽

Rib Cartilage ◽

Single Procedure ◽

Open Surgical Treatment

Posterior glottic and subglottic stenosis from endotracheal intubation in children can be managed endoscopically with varying success. Open surgical treatment offers a better potential for correction with a single procedure in moderate and severe cases. The open method consists of splitting the scar and cricoid cartilage posteriorly to the level of the interarytenoid muscle, then stenting the incised cricoid open with a rib cartilage graft. Use of this method is described, and results in 12 cases are reported. Decannulation was achieved in ten patients. In all patients who were decannulated, good exercise tolerance, freedom from aspiration, and an adequate voice quality were achieved.

Download Full-text