title: Buccal mucosa graft for laryngotracheal reconstruction in severe laryngeal stenosis.
abstract: OBJECTIVE
  An operative technique is described as a salvage treatment for severe subglottic and supraglottic laryngeal stenosis. In addition to expansion of the laryngeal framework with an anterior cartilage graft, as used in a classical laryngotracheal reconstruction, the scar tissue obliterating the airway lumen is excised and a mucosal graft is placed to reconstruct the inner lining of the airway. The graft is harvested from buccal mucosa.
  
  
  METHODS
  The operative technique is outlined. Three cases, 2 paediatric and one adult, with complete or near complete laryngeal stenosis are presented where this operative technique was employed. In all patients several surgeries had been performed previously which were unsuccessful.
  
  
  RESULTS
  In all 3 patients a patent airway was achieved with decannulation of the tracheostomy in the 2 paediatric patients.
  
  
  CONCLUSIONS
  In patients with severe subglottic or supraglottic airway stenosis where other surgeries have failed, excision of endoluminal scar tissue and placement of a buccal mucosal graft, in addition to conventional laryngotracheal reconstruction, is a promising technique. In revision cases of subglottic stenosis cricotracheal resection might not be an option because of scarring from previous surgeries. This operation is an alternative, which allows an increase in the airway lumen by excising the scar tissue then re-lining the exposed internal lumen. The buccal mucosa reduces granulation formation and re-stenosis.
authors.affiliation: Department of Paediatric Otolaryngology, Evelina Children's Hospital, Guys and St Thomas NHS Trust, London B74 2QH, United Kingdom. Electronic address: detrey@hotmail.com.
authors.forename: Lorraine A
authors.initials: LA
authors.lastname: de Trey
authors.forename: Gavin A
authors.initials: GA
authors.lastname: Morrison
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000175:diagnosis / Q000601:surgery; D002610:Cheek / Q000601:surgery; D002675:Child, Preschool; D002921:Cicatrix / Q000175:diagnosis / Q000601:surgery; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007829:Laryngostenosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D009061:Mouth Mucosa / Q000601:surgery / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016378:Tissue Transplantation / Q000379:methods*; D020858:Tissue and Organ Harvesting; D014135:Tracheal Stenosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
keywords: Buccal mucosa; Laryngotracheal reconstruction; Severe laryngeal stenosis; Severe subglottic stenosis; Severe supraglottic stenosis