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Cricoid arch replacement in dogs. Further studies.

Published reports by Delahunty et al and Alonso et al described the feasibility of correcting subglottic defects with cricoid arch transplantation. Using normal dogs, satisfactory results, including airway patency and vocal cord function, were reported. This report describes a second series of dogs in which subglottic stenosis was first induced by an open procedure and was subsequently repaired with an allotransplanted cricoid arch. The resulting subglottic defect in the donor dogs was repaired by autogenous hyoid arch transposition. No immunosuppressive measures or stents were used in either group. The animals were followed for periods up to one year prior to histologic study. Satisfactory results were obtained in both groups.

Animals↗

Repair of extended laryngotracheal stenosis.

The most challenging laryngotracheal stenosis are those that exceed 5 cm in length and involve more than one area of the larynx and trachea contiguously. A successful technique for the repair of these injuries with a three-stage laryngotracheal trough was created followed by anterior tracheal wall replacement with a skin-Marlex-muscle pedicle flap.

Adult↗

Treatment of the fractured larynx. Use of a new grafting technique.

Laryngeal fractures are best handled early by the meticulous apposition of mucous membrane and reconstitution of the laryngeal skeleton. Postoperative dilatations may deal successfully with any stenosis that occurs. However, the loss of critical supporting structures such as the cricoid ring or large amounts of mucosa may result in stenosis that requires the addition of structural elements from elsewhere in the body. This is a five-year follow-up on such a patient in whom ultimate reconstruction was accomplished by the use of mucous membrane from the maxillary sinus as a lining for the reconstructed larynx while costal cartilage provided additional supportive structural material for the compromised cricoid and thyroid cartilages.

Adult↗

Carbon dioxide laser treatment of laryngeal stenosis.

Six patients ranging from 3 to 67 years of age were treated for acquired laryngeal stenosis. Five of these patients were considered failures from conventional surgical techniques including multiple open endolaryngeal procedures and repeated dilations. Using the carbon dioxide laser, the various obstructing lesions were excised microendoscopically and injected with interstitial steroids. After one to six procedures, all of these patients now have adequate airways and serviceable voices.

Adult↗

Repair of subglottic stenosis with a free perichondrial graft.

Previous work with dogs has shown that a free perichondrial graft will predictably produce new cartilage when placed in the trachea. In the absence of a wound infection, the production of cartilage was predictable although the amount of cartilage varied. The present study sought to determine if enough cartilage could be produced to correct an acquired subglottic stenosis. In all dogs in whom a wound infection did not occur, enough cartilage was produced to support and maintain the subglottic lumen.

Animals↗