CPT® Code 31592

Cricotracheal resection is a surgical procedure aimed at removing a narrowed or scarred section of the airway located just below the larynx. This procedure is essential for restoring normal airflow by reattaching the larynx to healthy tracheal tissue. The narrowing or scarring of the trachea can occur due to various factors, including injury sustained during intubation or tracheostomy, the presence of a tracheal tumor or abnormal tissue growth, inflammatory diseases, or radiation therapy directed at the chest or neck. During the procedure, an endotracheal tube is inserted to deliver anesthesia and ensure that the airway remains open throughout the surgery. The surgical approach typically involves making a horizontal incision along the base of the neck, commonly referred to as the standard low collar line. This incision allows for the development of mucosal flaps in the subplatysmal plane, which exposes the airway from the hyoid bone at the top to the manubrium at the bottom. The procedure requires careful retraction of the strap muscles and division of the thyroid isthmus in the midline to gain access to the trachea. The surgeon identifies the distal end of the stenosis and mobilizes the trachea circumferentially to the inferior border of the cricoid cartilage. Blunt dissection along the anterior wall of the trachea to the level of the aortic arch or carina facilitates further mobilization and reduces tension during the anastomosis. Throughout the procedure, it is crucial to preserve the vascular supply with minimal lateral dissection. The cricoid muscle is then reflected superiorly, and the perichondrium on both the upper and lower borders of the cricoid cartilage is incised to allow for the excision of the anterior segment. The dissection continues carefully along the inner aspect of the cricoid cartilage, ensuring that the laryngeal nerves are preserved. The stenosis is excised from within the cricoid lumen while maintaining the integrity of the outer perichondrium of the cricoid plate. The cricoid plate is thinned posteriorly, and the distal and proximal margins of the stenosis are identified for en bloc resection. Finally, the transected normal trachea is telescoped into the posterior cricoid plate and sutured to the mucosal flap and thyroid cartilage. To maintain a patent airway postoperatively, a T-tube may be inserted into the trachea, and the incision is closed in layers. Chin to chest fixation sutures may also be placed to prevent neck flexion during the initial week of recovery.