Novel application of the Sonopet for endoscopic posterior split and cartilage graft laryngoplasty.

INTRODUCTION Posterior glottic stenosis (PGS) presents a challenge to the airway surgeon. A variety of techniques, ranging from endoscopic laser arytenoidectomy and partial cordotomy to open laryngotracheoplasty with anterior and posterior costal cartilage grafting, have been described with variable results in addressing this problem in adults. Endoscopic posterior cricoid split and rib graft (EPCS/RG) was first described in 2003 by Inglis et al. in 10 pediatric patients with PGS and subglottic stenosis as an alternative to open procedures. Adult patients present additional challenges to the airway surgeon. Increased incidence of cervical spine disease can make adequate exposure difficult in adult patients, and increased rates of ossification in the adult airway cartilages and mature scar tissue can make endoscopically splitting the cricoid difficult. The authors present a series of adult patients with PGS and tracheotomy dependence who were managed with EPCS/RG, although one patient was unable to complete the operation in a fully endoscopic fashion due to cricoid ossification. Challenges in intraoperative management will be discussed in presenting EPCS/RG as a feasible option for select adult patients. We herein present an algorithm that posits an ultrasonic aspirator as a solution to the problem of splitting an ossified cricoid seen more commonly in this population. MATERIALS AND METHODS