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Cricoid split in children: Treatment, symptoms, advice and help

 

Indications


The cricoid split operation is an operation aimed at widening the airway sufficiently to permit the extubation of babies and small children with developing subglottic stenosis.


The cricoid cartilage is the only complete ring of cartilage in the skeleton of the airway and is also its narrowest point. If the child has required ventilating for some time, the mucous membrane within the cricoid cartilage can become very swollen and inflamed and become squashed between the wall of the tube and the unyielding cricoid cartilage. This can give rise to scarring causing subsequent subglottic stenosis. The cricoid split operation is intended to release this pressure on the mucous membrane to give it a chance to recover without narrowing the airway.


Anaesthetic


The operation is performed under general anaesthetic.


Technique


A horizontal incision is made across the midline of the lower neck. The cricoid cartilage is exposed and a vertical incision is made in the airway, cutting the cricoid cartilage and sometimes the upper rings of the trachea. The wound is then closed with a drain.


Length of Operation


About half an hour. Postoperative, the endotracheal tube is left in place for 7 to 10 days.


Time in Hospital


This is unpredictable because it will depend upon the child's general condition.


Outcome


Results of cricoid split operation vary. It would be expected to permit the extubation of at least 50 % of the children who have the operation and thereby save the need for a tracheostomy.


Risks & Complications


Surgical emphysema in which air leaks out of the incised cricoid and builds up under the skin because it can not vent to the skin surface. This is usually prevented by adequate drainage.


Fistula - A permanent connection between the airway and the skin surface is a rare complication.


Alternative Treatments


It is frustrating to be unable to remove a ventilating tube from a child who no longer needs it. Sometimes a further period of waiting and extubation a few days later may be successful particularly if steroids are given to reduce any swelling of the subglottic mucous membrane. The other alternative treatment is the performance of a tracheostomy to bypass the blockage in the upper airway. This is still necessary in some cases and it is to avoid the need for tracheostomy that the cricoid split operation was first developed.