Experience with partial cricoid resection and thyrotracheal anastomosis.

Since 1973, 28 patients have undergone tracheal and subglottic resection with reconstruction by primary laryngotracheal anastomosis. Nine patients had postintubation stricture, eight had blunt trauma with cricotracheal disruption, seven had a neoplasm, two had an inhalation burn, and two had idiopathic stenosis. In all cases, the anterior cricoid arch was completely resected and a submucosal segment of the posterior cricoid plate was partially resected. A posterior shell of cricoid plate was preserved in 21 patients with intact laryngeal nerve function. Postoperatively, a Montgomery T-tube was used to stent the anastomosis and subglottic area in ten patients, all of whom had residual injury or disease at or immediately below the level of the cords. The proximal arm of the T-tube was positioned above the vocal cords. The tube was removed within 1 month in eight patients and remained for 3 and 18 months in the other two. The extent of resection varied from 2.5 to 7 cm. Tension-relieving procedures were added in 13 cases. Fourteen patients have been followed longer than 5 years, and five patients for more than 10 years. A widely patent anastomosis was maintained in 26 patients. In two patients, a partial restenosis resulted in some limitations of exercise tolerance. Voice and exercise tolerance have not deteriorated with the passage of time. Recurrent laryngeal nerve function was completely preserved in 20 of the 21 patients whose nerve function was intact before operation.