Does the cricoid resection increase the risk of complications in the surgical treatment of benign laryngotracheal stenoses?

Abstract

Purpose: The most of post-intubation stenoses occurs in the cricotracheal segment and require open surgery. Resection of the cricoid arch is a part of the surgical technique that carries certain difficulties. Resection of the cricoid arch, sometimes also the posterior cricoids plate, is part of a surgical technique that carries potential risks of complications, due to the proximity of the recurrent nerve and the need to preserve the airway lumen, in which the cricoids cartilage plays a central role. Purpose of this study is to evaluate whether resection of the cricoid cartilage is associated with a higher incidence of postoperative complications, increased need for additional interventions, prolonged patient recovery, extended hospitalization, and ultimately, a less favorable outcome in the surgical management of cricotracheal stenosis.

Methods: Retrospective analysis of 75 elderly patients with circotracheal stenosis divided in two groups: group I with resection of the cricoid arch, group II with submucosal resection of the stenotic connective tissue and preservation of the cricoid arch.

Results: There is no difference in the length of the resected segment, 3.54 cm-3.48 cm (p = 0.32). Mobilization of the larynx was performed in 13/23 and 21/52 p = 0.004. Postoperatively, 6/23 and 4/52 had a recurrent nerve lesion, p = 0.02. The most common postoperative complications are granulations at the suture line in 21/75 (28%) patients, 12/23 (52.1%) and 9/52 (17.3%) p = 0.008. One patient died (1.3%). Normal respiratory function, without need for tracheostomy, had 98.6% of patients.

Conclusion: Resection of the cricoid arch carries an increased risk of postoperative complications, most often granulation and recurrent nerve lesions, but they don't affect the final outcome of treatment.