Abstract
It has been generally accepted that the reconstruction of the airway and subsequent decannulation are very difficult in infants with a subglottic stenosis. Lapidot (1968) and Fearon (1972) reported experimental results of a new surgical technique “thyrochondroplasty” performed in piglets and monkeys. Fearon showed three ways in using the cartilage flap; the first method is to use it like a trapdoor, the second to use it as a rotating pedicle flap, and the third as a free graft.
Fearon's experimental second techniqne was clinically applied to a five-year-old boy with a subglottic stenosis caused by the naso-tracheal intubation for 36 days. The cricoid and the inferior part of thyroid cartilage were anteriorly divided and the cicatricial tissue was completely removed. A vinyl tube slightly larger than the subglottic lumen was wrapped in a split free skin graft. This tube was placed in the subglottic raw area as a stent. A block of the thyroid ala was incised with the outer perichondrium connecting to the cricothyroid membrane and rotated as a pedicle and fitted between the cut edges of the cricoid cartilage. The perichondrium of the block was sutured with that of the cricoid cartilage to prevent the slipping. Then the subglottic space was closed and the stent was fixed in place with penetrating nylon threads through the skin.
The stent was removed under laryngomicroscope five weeks after the surgery. The subglottic space has been maintained to be quite wide and the voice is good. The thyrochondroplasty with the usual method using free skin graft and stent is emphasized as the most hopeful treatment to correct the subglottic stenosis in infants and children.
