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A. Circumferential stenosis of the subglottis and superior trachea. Dashed lines represent the external extent of resection. A lateral transection through the
cricoid lamina allows removal of the anterior cricoid arch while preserving the posterior cricoid lamina, thereby protecting the recurrent laryngeal nerves. A
posterior membranous tracheal wall flap is formed distally. B. The superior line of resection is through the cricothyroid membrane, curving inferiorly
through the lateral cricoid laminae. The first preserved tracheal ring is shaped into an inverted U for anastomosis directly to the thyroid cartilage. If a longer
posterior flap is required for reconstruction, the level of tracheal resection may be dropped by an additional ring. C. The internal line of resection (dotted
line) removes the stenosis involving the posterior cricoid lamina. With neoplasms that involve the cricoid, the posterior lamina may be resected, but the
Source: Chapter 55. Subglottic Resection of the Airway, Adult Chest Surgery
posterior perichondrium and a superior horizontal strut of cartilage should be preserved to maintain arytenoid stability and posterior muscular attachments.
Citation:
Sugarbaker
Bueno
R, is
Krasna
MJ,with
Mentzer
SJ, Zellos L. flap
Adult
Chest
Available
at: http://mhmedical.com/
D. The denuded
posterior
lamina DJ,
of the
cricoid
covered
the membranous
from
theSurgery;
posterior2009
trachea.
The first
tracheal ring is shapedAccessed:
to fit the
May
09,
2017
inferior thyroid cartilage resection line. E. 4-0 Vicryl is used internally to close the mucosal defect over the posterior cricoid lamina. 3-0 Vicryl suture is used
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Education.
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to anastomose
the tracheal
ringMcGraw-Hill
to the thyroid
and cricoid
and to anchor the base of the membranous flap to the posterior cricoid cartilage, taking
care not to injure the recurrent laryngeal nerves. All knots are tied outside the lumen. F. The superior trachea is anastomosed to the thyroid cartilage with