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October 1992

Four-Quadrant Cricoid Cartilage Division in Laryngotracheal Reconstruction

Author Affiliations

From the Department of Otolaryngology and Maxillofacial Surgery, University of Cincinnati (Ohio) College of Medicine, Children's Hospital Medical Center.

Arch Otolaryngol Head Neck Surg. 1992;118(10):1023-1027. doi:10.1001/archotol.1992.01880100013005

• Four-quadrant division of the cricoid cartilage is a relatively new technique of laryngotracheal reconstruction. Division of the lateral walls of the cricoid cartilage, with or without placement of autogenous cartilage grafts, allows for increased expansion of the subglottic lumen. Between October 1, 1986, and January 1, 1990, 185 laryngotracheal reconstructions were performed at our institution. During that time, 31 four-quadrant division laryngotracheal reconstruction procedures were performed in 29 patients (mean age at surgery, 5 years 5 months). Grade 3 or 4 laryngeal stenosis existed preoperatively in 72% (22/31) of cases. The initial decannulation rate after four-quadrant division laryngotracheal reconstruction was 58% (18/31). Of 11 patients requiring revision surgery after four-quadrant division laryngotracheal reconstruction, four were eventually decannulated, for an overall decannulation rate of 76% (22/29). The indications, technique, results, and potential complications of four-quadrant division of the cricoid cartilage in laryngotracheal reconstruction are discussed.

(Arch Otolaryngol Head Neck Surg. 1992;118:1023-1027)

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