Izadi Farzad, Vaghardoost Reza, Derakhshandeh Vita, Sobouti Behnam, Ghavami Yaser
Department of Otorhinolaryngology, Iran University of Medical Sciences, Tehran, Iran.
Department of Aesthetic and Reconstructive, Iran University of Medical Sciences, Tehran, Iran.
Iran J Otorhinolaryngol. 2016 Mar;28(85):159-62.
Laryngotracheal stenosis can be caused after traumatic injuries to the neck from the subglottic larynx to the trachea. Patients with laryngotracheal stenosis often need a tracheotomy and occasionally may become tracheotomy dependent. Different procedures have been described for the management of these lesions. Management options include techniques of endoscopic dilation, laser resection, laryngo-fissure, and an innovative array of plastic reconstructions with or without the use of stents.
This paper presents airway reconstruction in a young patient with severe subglottic stenosis due to a blunt trauma to the neck, who was treated using particles of an autologous fractured cricoid cartilage as the source for airway augmentation. An incision was made in the anterior midline of the cricoid lamina and deepened through the scar tissue to the posterior cricoid lamina. Then two lateral incisions (right & left) were made in the cricoid lamina and fractured cartilage particles and the scar tissue were removed via these two lateral incisions. The mucosal lining at the right and left of the midline incision, after debulking, were sutured to a lateral position. Thereafter three cartilage particles were used to reconstruct the anterior cricoid lamina and augment the lumen.
It is worth to mention that an autologus cartilage graft can be used for certain cases with traumatic airway stenosis. Further follow up and more patients are needed to approve this method of reconstructive surgery in emergent situations.
喉气管狭窄可由颈部从声门下喉至气管的创伤性损伤引起。喉气管狭窄患者通常需要气管切开术，偶尔可能会对气管切开术产生依赖。针对这些病变的处理已有不同的手术方法描述。处理选项包括内镜扩张技术、激光切除、喉裂开术，以及一系列创新的整形重建方法，可使用或不使用支架。
本文介绍了一名因颈部钝性创伤导致严重声门下狭窄的年轻患者的气道重建情况，该患者使用自体环状软骨骨折颗粒作为气道扩大的来源进行治疗。在环状软骨板前中线做切口，穿过瘢痕组织深入至环状软骨后板。然后在环状软骨板上做两个外侧切口（右侧和左侧），通过这两个外侧切口取出骨折软骨颗粒和瘢痕组织。中线切口两侧的黏膜衬里在减容后缝合至外侧位置。此后，使用三个软骨颗粒重建环状软骨前板并扩大管腔。
值得一提的是，自体软骨移植可用于某些创伤性气道狭窄病例。需要进一步随访并纳入更多患者，以认可这种在紧急情况下的重建手术方法。
