Anterior cricoid suspension and tracheal stomal closure for children with cricoid collapse and peristomal tracheomalacia following tracheostomy.

Nearly 10% of infants with long-standing tracheostomies (> 1 year) have severe peristomal tracheomalacia and/or significant cricoid cartilage collapse. Tracheal decannulation in these small children may be complicated by upper airway obstruction, recurring respiratory tract infections, and an unsightly cervical scar. We have developed a simple one-stage method of surgically alleviating severe cricoid collapse and peristomal tracheomalacia that permits immediate extubation. After excising and transversely closing the tracheocutaneous fistula, an anterior cricoid/tracheal suspension is accomplished by suturing the adherent fibromuscular tissue overlying the cricoid and peristomal trachea to the musculofascial insertions of the cervical strap muscles adjacent to the sternum. Once tied, these sutures significantly elevate the anterior cricoid and peristomal trachea by pulling the cervical airway ventrally and inferiorly. The strap muscles cover the tracheal suture line and the skin and soft tissue are closed in a transverse fashion. This procedure has been performed in 9 children (ages 1 to 4 years). All were extubated within 24 to 72 hours. No perioperative or long-term complications were observed with follow-up averaging 20 months (range, 6 months to 4 years). Postoperative endoscopy demonstrated substantial improvement in the airway lumens of all children. The final cosmetic appearance has been excellent. This operative method of dealing with cricoid collapse and peristomal tracheomalacia is simple, safe, and effective.