Treatment of Subglottic Stenosis with Composite Nasal Septal Cartilage Graft.

Four cases of severe subglottic stenosis are reported. The causes of stenosis were long time intubation in two cases, laryngeal injury in one case, and a scar caused by radiation in one case.All cases were treated by two-stage laryngotracheal reconstruction. First, we made a laryngotracheal fissure, and removed the subglottic granulation or scar tissue. After about three month's observation, we reconstructed the anterior tracheal wall with a composite nasal septal cartilage graft (nasal septal cartilage with the unilateral mucoperichondrium) and covered the cartilage with an advanced cervical skin flap, reserving a small stoma for respiration. After three months observation, the stoma was closed in three of four patients. However, in one patient with laryngeal injury the stoma was required for respiration.We consider that a composite nasal septal cartilage graft is suitable for the reconstruction of the anterior tracheal wall in adults because it is easy to obtain the graft, and because the transplantation and reconstruction of the anterior wall of the larynx and trachea with the composite nasal septal cartilage are both safe and relatively simple.