Endoscopic Laryngotracheoplasty and Graft Soldering with the Carbon Dioxide Laser

Abstract

Laryngotracheoplasty (LTP) has had considerable success for treatment of selected cases of subglottic stenosis in children. However, certain complications have been associated with an open approach. Our study explores the possibility of decreasing these complications by means of a minimally traumatic endoscopic laser cricoid split and graft transplantation technique. In an in vivo study of six dogs, LTP was performed with a carbon dioxide laser. The gap between the divided cricoid cartilage was either left with no coverage or filled by autogenous mucosa or cartilage grafts through a laser-assisted soldering technique. Compared to LTP without coverage, autogenous grafts, with either mucosa or cartilage, resulted in improved healing. The cartilage graft seems to offer the best result for expansion of the subglottic space. The results show that the new intraluminal approach, a combination of an endoscopic cartilage split and graft transplantation, may be an alternative to standard LTP. The advantage of this technique is that it is less traumatic than the open procedure, with the potential for less morbidity.