Transcutaneous identification of cricotracheal and tracheal stenosis

Background. In the reconstruction of laryngotracheal stenosis, the exact localization of the level of the stenosis in relation to the cricoid arch is of paramount importance. This report describes an easy, fast and reliable technique for projecting stenotic segments of the subglottic trachea onto the tracheal front wall. Material and method. Directly before the reconstructive procedure, the stenosis is visualized using microlaryngoscopy. An endo-extralaryngeal needle-carrier is used to drive a suture from the inside through the skin. This takes the surgeon directly to the anterior tracheal wall at the exact level of the upper margin of the stenotic segment. Results. This technique has been used in 15 cases, allowing the correct identification of the stenosis in every case. Subjectively, there was a gain of time as well as of the surgeon's confidence in this critical part of the procedure. The transcutaneous identification of a laryngotracheal stenosis using the Lichtenberger endo-extralaryngeal suture technique requires a minimum of additional time. We recommend this technique for routine use whenever an open approach for airway reconstruction of the subglottic larynx or proximal trachea is to be performed.