Introduction: Cricotracheal resections and tracheal resections are highly successful procedures for the treatment of severe airway pathology including high-grade stenoses. The major complication of resection is anastomotic dehiscence and various methods have been developed to decrease this complication including cervical flexion, the guardian suture, braces, cervical and intrathoracic releasing procedures. We have recently become aware of a potential association between quadriplegia and cricotracheal resections and tracheal resections.
Objectives: To identify cases of quadriplegia associated with cricotracheal resections and/or tracheal resections and to identify commonalities.
Methods: After a case of quadriplegia was identified, a thorough review of the medical literature was performed including search for quadriplegia, tetraplegia, paralysis and cricotracheal resection, tracheal resection, Grillo stitch, cervical flexion, subglottic stenosis, tracheal stenosis. All references within these papers were similarly examined.
Results: Six case reports of quadriplegia associated with airway surgery were in obscure medical literature. We present a summary of patient demographics, etiology, and underlying pathology, type of surgery, risk factors, management and outcomes. Additional cases that have not been reported were identified in discussions with airway surgeons. Spinal cord dysfunction can be reversible but is often unpredictable.
Conclusions: Quadriplegia following CTR or TR is an extremely rare but devastating complication of unknown pathogenesis. Cervical flexion is a common but not universal finding. Potential interventions are discussed.
Cricotracheal resection; Tracheal resection; Subglottic stenosis; Tracheal stenosis; Airway reconstruction; Complication; Tetraplegia; Quadriplegia; Paralysis; Paraplegia; Neck brace; Chin-to-chest suture; Cervical flexion; Cervical flexion myelopathy