Surgical Closure of the Larynx by Removing Cricoid Cartilage for Airway Management without a Tracheal Cannula

Abstract

The main surgical procedures for aspiration prevention surgery are total laryngectomy, separation of the larynx from the trachea, and laryngeal closure. Laryngeal closure has the benefit of being minimally invasive and has thus far been reported many times. However, a tracheal cannula needs to be placed after this surgery. In 2008, we reported on the surgical closure of the larynx by removing the cricoid cartilage. The plasty of tracheostoma in this procedure involves the removal of the cricoid cartilage arch and the subsequent formation of a tracheal hole using the residual “lamina” and tracheal ring as a frame. The tracheal hole becomes triangular in shape with the posterior wall of the glottis at its apex. The rigid “lamina” forming the posterior wall allows this large hole to be maintained as-is without constricting. Furthermore, this “lamina” of the cricoid cartilage constitutes an important structure that reduces the risk of stenosis and prevents obstruction of the tracheal hole due to twisting or bending the neck. This procedure is one method of minimally invasive surgical closure of the larynx, and in addition to preventing aspiration from closure of the glottis, it is a useful surgery emphasized by its ability to meet the expectation of performing unique plasty of tracheostoma without a tracheal cannula.