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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: Subglottic Resection of the Airway, Adult Chest Surgery, 2e
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
Colson
YL,with
Jaklitsch
MT, Krasna MJ,
Williams
M, Adams
A. Adult
Chest
Surgery,
2e; 2015
D. The denuded
posterior
lamina DJ,
of the
cricoid
covered
the membranous
flap Mentzer
from theSJ,
posterior
trachea.
The first
tracheal
ring
is shaped
to fit the
Available
at:
http://mhmedical.com/
Accessed:
April
29,
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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rights reserved
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