Tracheal release maneuvers.

Careful preoperative trachea "mapping" with accurate measurements should make an unexpected shortfall in remaining tracheal length and mobility uncommon. Bronchoscopy is the most accurate means of "mapping" the pathologic tracheal anatomy. Rigid bronchoscopy using the ventilating bronchoscope is preferred over flexible bronchoscopy because it provides the most accurate means of measuring the length of stenotic trachea (especially when used in conjunction with rigid fiberoptic telescopes), it can be used to dilate a tracheal stenosis before operative repair, and it establishes a safe airway under direct vision. When the anatomy of the tracheal pathology is accurately defined, specific plans for tracheal resection can be established to accomplish a well-vascularized, low-tension tracheal anastomosis.