STUDY OF FUNCTIONAL OUTCOME OF LARYNGOTRACHEAL RECONSTRUCTION USING ILIAC CREST GRAFT

Objectives: Laryngotracheal stenosis is a challenging problem, and its management is complex. In this article we are studying the functional outcome after silicon T tube stenting with iliac crest graft.

Methods: From 1997 to 2010, 13 patients underwent laryngotracheal reconstruction for benign stenoses most commonly following prolonged intubation. There were 8 males and 5 females with a median age of 18.5 years (range 7- 30 years). Out of 13 pt, 3 (23.07%) cases had history of strangulation following the use of rural threshers, 2 (15.4%) were intubated following organophosphoras poisoning, 2(15.4%) had history of failed laryngeal LASER surgeries, 2 (15.4%) patients were intubated following road traffic accidents, 2 (15.4%) had history of cut throat, 1 (.076%) had history of endotracheal intubation for prolonged period because of medical reason, and 1 (.076%) patient had history of throttling. At the time of surgery all patients had to undergo tracheostomy. All these patients received silicone T-tubes for stenting of the airway for three months. The upper limit of the stenosis was from 0 .5 - 1 cm below the vocal cords. Mean follow-up is over 3 years.

Results: Amongst 13 patients, 7 patients had undergone corrective treatment previously. Corrective measures consisted of a Shiann yann lee technique, laser therapy, and tracheostomy and T tube stenting amongst others. Amongst 13 patients, 11 patients were weaned of tracheostomy and had significant improvement in voice, 7 patients had functional larynx. 1 patient had persistent aspiration after operation, and in 1 patient the result was not satisfactory. In classifying final results, laryngotracheal stenosis obtained, 7 patients achieved an excellent result, 4 had good result, and 1 had persistent aspiration and one case failed. Long-term follow-up was uneventful also in patients who had early minor complications.

Conclusions: Modified Shiann Yaan Lee technique with silicon T tube stent using iliac crest graft with its perichondrium can effectively resolve the complex laryngotracheal lesions with functioning larynx and limited complications. Laryngo pharyngeal reflux, recurrent polychondritis and intractable infection were the major causes for failure after the T-tube reconstruction. Long-term follow-up confirms that laryngotracheal reconstruction is the definitive curative treatment for benign subglottic stenosis.