Abstract
Laryngotracheal stenosis in children is located mainly in a subglottic lesion, and the primary cause of subglottic stenosis is prolonged endotracheal intubation in respiratory management. We report the case of a 15-year-old boy with bilateral vocal cord immobility accompanied with grade III subglottic stenosis. He had congenital thyroid teratoma and underwent a total thyroidectomy after birth. He was intubated after the operation, and tracheostomy was performed at 1 month of age. Over the next 15 years, he remained tracheotomy-dependent. Flexible laryngoscopy revealed bilateral vocal fold immobility with marked deviation of the left arytenoid that prolapsed into his airway. Direct laryngoscopy under general anesthesia showed cricoarytenoid joint fixation and grade III subglottic stenosis. A laryngeal expansion procedure with anterior and posterior cricoid split was performed. The laryngotracheal complex was entered through a laryngofissure (midline) approach. The posterior laryngeal surface and cricoid were divided and separated along the midline to accommodate the posterior cartilage graft. Costal cartilage grafts were placed at the anterior and posterior cricoid plates to widen the diameter of the glottis and subglottic lumen. After stent removal, endoscopic interventions were performed, and no obvious airway stenosis was identified. Decannulation was achieved approximately 3 months after the reconstruction, and the tracheostoma was closed approximately 7 months after. A posterior graft is considered to be required when there is posterior stenosis such as cricoarytenoid joint fixation.
