title: Cervical tracheal resection with cricotracheal anastomosis: experience in adults with grade III-IV tracheal stenosis.
abstract: BACKGROUND
  Laryngotracheal stenosis is currently one of the most common complications associated with nasal and orotracheal intubation and tracheotomy. Once established, tracheal stenosis can be a complex and difficult problem to manage.
  
  
  METHODS
  We retrospectively analysed 2004-2010 data for 12 male patients with postintubation cervical tracheal stenosis (grade III-IV) treated in the otolaryngology department, Mansoura University Hospitals. All patients had a tracheostomy at presentation, and all underwent tracheal resection with primary cricotracheal anastomosis and suprahyoid release.
  
  
  RESULTS
  Grade III stenosis was present in five patients (41.7 per cent) and grade IV stenosis in seven patients (58.3 per cent). The length of trachea resected ranged from 2 to 4 cm, representing one to four tracheal rings. In all 12 patients, the procedure allowed successful tracheotomy decannulation. Minor complications comprised surgical emphysema (n = 2) and wound infection (n = 1), and were managed conservatively. Major complications consisted of restenosis (n = 3), managed in two patients by repeated dilatation; one patient was lost to follow up.
  
  
  CONCLUSIONS
  Segmental tracheal resection with cricotracheal anastomosis was successful in 11/12 (92 per cent) patients with severe cervical tracheal stenosis. The strategy for treatment of airway stenosis is now well established and success rates are high, with minimal or no sequelae.
authors.affiliation: Otolaryngology Department, Faculty of Medicine, Mansoura University, Egypt. ahmusaad@mans.edu.eg
authors.forename: A M A
authors.initials: AM
authors.lastname: El-Fattah
authors.forename: E
authors.initials: E
authors.lastname: Kamal
authors.forename: H E
authors.initials: HE
authors.lastname: Amer
authors.forename: M
authors.initials: M
authors.lastname: Fouda
authors.forename: A E M A
authors.initials: AE
authors.lastname: Elwahab
authors.forename: A
authors.initials: A
authors.lastname: Tawfik
mesh_terms: D000328:Adult; D058109:Airway Management / Q000009:adverse effects / Q000379:methods*; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D003413:Cricoid Cartilage / Q000601:surgery*; D004106:Dilatation; D004646:Emphysema / Q000209:etiology; D004724:Endoscopy / Q000379:methods; D006801:Humans; D006928:Hyoid Bone; D007829:Laryngostenosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013530:Surgical Wound Infection; D014135:Tracheal Stenosis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D014140:Tracheotomy / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult