Medical Animation: Posterior Cricoid Split | Cincinnati Children's

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Subglottic stenosis is the narrowing of the airway (larynx) just below the vocal folds. The larynx is divided into an upper region (supraglottis), middle region (glottis) and lower region (subglottis). In a child, the narrowest part of the airway is the cricoid cartilage which sits slightly below the vocal cords. Subglottic stenosis can be congenital or acquired. Acquired subglottic stenois is more common and is often related to prolonged intubation or trauma. There are other reasons for excessive narrowing in this region as well.
Laryngotracheoplasty is a procedure done to improve this narrowing and the breathing. In this example a portion of the child’s rib is used as a ‘graft’ to open up the airway. A small segment of rib is removed from the front part of the rib cage. That piece of rib is then trimmed to a predetermined shape to be used as a graft. In this procedure, an incision is made in the front of the cricoid and the trachea, to expose the back wall of the trachea and cricoid. An additional incision is then made in the posterior wall of the cricoid, being very careful not to injure the esophagus that lies just behind it. The pre-cut rib graft is placed into the incision. Sutures are usually not needed as the shape of the graft and structure of the cricoid allows the graft to snap in securely. The anterior opening of the trachea is sutured closed. The airway diameter is then greatly improved by the insertion of the graft.
Credits:
Created by the Cincinnati Children's Media Lab
Animation: Elizabeth Young and Jeff Cimprich
Media lab Direction and additional content expertise: Ken Tegtmeyer, MD
Voiceover and Content Experts: Alessandro de Alarcon, MD, MPH