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

Jeroen Meulemans ^1* Laila Mouqni ¹ Noah Ostyn ¹ Davide Di Santo ¹ Vincent Vander Poorten ¹ Christophe Dooms ² Nico De Crem ² Paul De Leyn ³ Ann Goeleven ¹ Greet Hens ¹ Pierre Delaere ¹

• ¹ Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Brussels, Belgium
• ² Department of pulmonology, university hospitals Leuven, Leuven, Belgium
• ³ Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Brussels, Belgium

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 ((P)CTRPCTR) offers the most durable results. This study aims at reporting and analysing complications and respiratory and vocal outcomes after (P)CTRPCTR.Methods: For this retrospective cohort analysis, the files of 37 patients with SGS who underwent (P)CTRPCTR 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% versus 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 (P)CTRPCTR was fibrin deposit/granulation tissue formation at the anastomotic site (n=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, p= 0.036).Conclusion: (P)CTRPCTR is an efficient treatment for SGS, with low complication rates, a low rate of long-term restenosis and good vocal outcomes.