Discussion of Subglottic Stenosis Treatment

Discussion of Subglottic Stenosis Treatment

Karen B. Zur, MD: Subglottic stenosis is a little more common in children because the cricoid cartilage, which is the narrowest portion of our airway, is a signet-shaped ring that sits right below the vocal cords, and that area is vulnerable to intubation trauma. So there are many premature babies who are born who have to have a breathing tube in place for an extended period of time that could cause some narrowing in that area. So acquired subglottic stenosis is a very common reason why we end up performing laryngotracheal reconstruction. 

Ian N. Jacobs, MD: Laryngotracheal reconstruction, or LTR, involves reconstruction using cartilage grafts to expand or enlarge the airway. These cartilage grafts are borrowed from the rib. So cartilage can be easily transplanted from one portion of the body to the other and will survive in a remarkable fashion. And what it's used as is a spacer. In other words, it enlarges the size of the airway.

Karen B. Zur, MD: We're going to be splitting up the cricoid cartilage and the trachea in the midline and then importing a piece of rib cartilage. Or it could be another type of cartilage, but most commonly a rib cartilage. The piece of graft is shaped to fit that defect and then it gets snapped into the area between those split ends of the cricoid. 

Ian N. Jacobs, MD: We take a very narrowed airway and we'll transect that airway in one or two positions and place one of these spacers in there to dramatically enlarge the size of the airway.

Mother: The cartilage, actually, he said, just went beautifully into her airway.

Father: And where they had done the graft, you could see that new tissue was growing around the graft.

Mother: And the cartilage is now just going to become part of her airway. And eventually when you go down there with another scope, you won't even see it.