Laryngeal split and rib cartilage interpositional grafting: Treatment option for glottic/subglottic stenosis in adults

Standard laryngotracheal reconstruction. A, Laryngotracheal anterior exposure: 1, thyroid cartilage; 2, cricoid cartilage; 3, incision site to perform the anterior laryngeal split. B, Airway exposure after anterior laryngeal split: 1, thyroid cartilage split and retracted; 2, cricoid cartilage split and retracted; 3, arytenoids; 4, posterior cricoid plate, exposed and ready to be split. C, Posterior larynx grafting after posterior cricoid split: 1, arytenoids; 2, posterior cricoid plate already opened; 3, rib cartilage graft filling the posterior groove. D, Laryngeal stent and anterior grafting: 1, solid stent inside the airway; 2, rib cartilage graft prepared to fill the anterior defect.

Laryngotracheal reconstruction associated with cricotracheal resection. A, Larynx apart from the trachea, anterior laryngeal split and cricotracheal resection already performed: 1, thyroid cartilage split and retracted; 2, posterior cricoid (anterior arch already resected); 3, arytenoid cartilage; 4, tracheal posterior wall flap; 5, remaining healthy trachea. B, Cartilage grafting after posterior cricoid split: 1, posterior cricoid already split; 2, rib cartilage graft filling the posterior cricoid plate groove. C, Posterolateral cricotracheal anastomosis hiding the posterior cartilage graft: 1, posterior cricoid cartilage; 2, posterior tracheal wall flap sutured to posterior cricoid remnant mucosa; 3, healthy trachea, posterolateral anastomosis with the larynx already completed. D, Laryngeal stent and anterior grafting: 1, laryngeal stent; 2, trachea, tracheostomy already performed; 3, rib cartilage graft prepared to fill the anterior defect.

A, Saggital cervical computed tomographic scan showing glottic/subglottic stenosis (arrow): 1, arytenoid cartilage; 2, anterior cricoid arch. B, Axial cervical computed tomographic scan showing severe glottic stenosis (arrow): 1, thyroid cartilage; 2, asymmetric arytenoids. C, Postoperative neck computed tomographic scan showing cricoid cartilage with anterior and posterior discontinuity (arrows) caused by the laryngeal split; the patient still has the T-tube placed. D, Postoperative endoscopy showing an adequate laryngeal lumen: 1, overgrowth of the mucosa over the cartilage graft; 2, arytenoid cartilage.