Abstract
Seven cases of subglottic stenosis were successfully treated by the “trough method”. Four different techniques for closing the trough anteriorly were described.
1) Skin flap: The trough was closed with a hinge skin flap internally and with an advancement rotation skin flap externally in cases without deformity of the cartilagenous framework.
In cases where the trough opening had been reduced spontaneously without narrowing of the lumen during extremely long stenting, the remaining opening was closed with a bipedicle skin flap from the neck.
2) Auricular composite graft: The anterior laryngotracheal wall was reconstructed with an auricular composite graft in three infant and child cases. The skin of the graft was sutured to the mucosa, and the cartilage was sutured to that of the larynx and trachea. The exposed cartilage of the graft was covered externally with an advancement rotation flap from the adjacent area.
3) Rib cartilage (two-stage): Struts of rib cartilage were embedded beneath the skin adjacent to the laryngotracheal trough. Two months later the anterior laryngotracheal wall was reconstructed with a hinge skin graft with incorporated rib cartilage. The entire area was then covered with an advancement rotation flap.
4) Rib cartilage (one-stage): The trough was closed in one stage with a hinge skin flap internally, struts of rib cartilage intermediately and an advancement rotation flap externally. The struts of cartilage were inserted between the cut ends of the laryngotracheal cartilages, and both edges of the trough were thereby firmly supported.
Thus, there are various techniques for closing a laryngotracheal trough. The most effective method should be selected for each case, considering such factors as the severity and extent of the stenosis.
