Partial cricotracheal resection for treatment of subglottic stenosis: complications and outcomes.

Purpose: Subglottic stenosis (SGS) is defined as an obstruction of the subglottic area, potentially extending towards the first tracheal rings. Although endoscopic procedures are frequently preferred as first-line treatment, (partial) cricotracheal resection (PCTR) offers the most durable results. This study aims at reporting and analysing complications and respiratory and vocal outcomes after PCTR.

Methods: For this retrospective cohort analysis, the files of 37 patients with SGS who underwent PCTR in a tertiary referral center were reviewed. Patient- and stenosis-characteristics along with postoperative outcomes and complications were analyzed using descriptive statistics.

Results: The majority of patients were female (95%), which reflects the high incidence of idiopathic SGS in our patient group (89.2% vs. 2.7% postintubation SGS and 8.1% SGS related to systemic inflammatory disease). Most patients presented with a Cotton grade II (35.1%) and III (54.1%) stenosis, with a mean craniocaudal stenosis length of 17.5 mm. The vast majority of patients (89.2%) had undergone previous endoscopic procedures. The most common complication after PCTR was fibrin deposit/granulation tissue formation at the anastomotic site ( = 15, 40.5%). Other complications were rare, with anastomotic dehiscence, postoperative haemorrhage and vocal cord paralysis each in 1 patient (2.7%), temporary tracheostomy in 2 patients (5.4%), and postoperative wound infection in 3 patients (8.1%). During follow-up, only 2 patients (5.4%) developed restenosis which was successfully salvaged by endoscopic procedures. No patients were long-term tracheostomy dependent. Post-operative mean peak expiratory flow (PEF) percentage showed a 43.7% increase compared to pre-operative. For the mean increase in maximum inspiratory flow (MIF) at 50% this was 1.3 L/s. VHI (voice handicap index) scores increased significantly from baseline preoperative score of 27.5 (±23.7) to a mean value of 54.9 (±18.7) (p = 0.002) 1-month postoperatively but decreased below preoperative scores after 2 years (22.2 ± 18.1,  = 0.036).

Conclusion: PCTR is an efficient treatment for SGS, with low complication rates, a low rate of long-term restenosis and good vocal outcomes.