Conditioning the cochlea to facilitate survival and integration of exogenous cells into the auditory epithelium.

The mammalian auditory epithelium (AE) cannot replace supporting cells and hair cells once they are lost. Therefore, sensorineural hearing loss associated with missing cells is permanent. This inability to regenerate critical cell types makes the AE a potential target for cell replacement therapies such as stem cell transplantation. Inserting stem cells into the AE of deaf ears is a complicated task due to the hostile, high potassium environment of the scala media in the cochlea, and the robust junctional complexes between cells in the AE that resist stem cell integration. Here, we evaluate whether temporarily reducing potassium levels in the scala media and disrupting the junctions in the AE make the cochlear environment more receptive and facilitate survival and integration of transplanted cells. We used sodium caprate to transiently disrupt the AE junctions, replaced endolymph with perilymph, and blocked stria vascularis pumps with furosemide. We determined that these three steps facilitated survival of HeLa cells in the scala media for at least 7 days and that some of the implanted cells formed a junctional contact with native AE cells. The data suggest that manipulation of the cochlear environment facilitates survival and integration of exogenously transplanted HeLa cells in the scala media.

Salivary gland disorders.

Salivary gland disorders include inflammatory, bacterial, viral, and neoplastic etiologies. The presentation can be acute, recurrent, or chronic. Acute suppurative sialadenitis presents as rapid-onset pain and swelling and is treated with antibiotics, salivary massage, hydration, and sialagogues such as lemon drops or vitamin C lozenges. Viral etiologies include mumps and human immunodeficiency virus, and treatment is directed at the underlying disease. Recurrent or chronic sialadenitis is more likely to be inflammatory than infectious; examples include recurrent parotitis of childhood and sialolithiasis. Inflammation is commonly caused by an obstruction such as a stone or duct stricture. Management is directed at relieving the obstruction. Benign and malignant tumors can occur in the salivary glands and usually present as a painless solitary neck mass. Diagnosis is made by imaging (e.g., ultrasonography, computed tomography, magnetic resonance imaging) and biopsy (initially with fine-needle aspiration). Overall, most salivary gland tumors are benign and can be treated with surgical excision.

Orbitocranial approach for treatment of adenoid cystic carcinoma of the lacrimal gland.

OBJECTIVES: Multiple treatment options exist for management of adenoid cystic carcinoma of the lacrimal gland. Our objective was to perform an analysis of outcomes in a cohort of patients with adenoid cystic carcinoma of the lacrimal gland treated identically with an orbitocranial approach. METHODS: We performed a retrospective review of 7 consecutive patients who presented to a tertiary care academic medical center between 1995 and 2009 with adenoid cystic carcinoma of the lacrimal gland. RESULTS: All patients were treated with an orbitocranial approach to tumor resection followed by postoperative radiotherapy. The mean and median follow-up times were 39 and 19 months, respectively (range, 7 to 138 months). Six patients had orbital reconstruction using free tissue transfer, and 1 patient had a split-thickness skin graft to line the orbital cavity. Two patients developed distant metastases 18 months and 29 months after surgery and ultimately died with disease. Five patients are alive without disease. CONCLUSIONS: The orbitocranial approach followed by postoperative irradiation achieves excellent local and regional control rates for adenoid cystic carcinoma of the lacrimal gland, although patients remain at risk long-term for distant metastases. Orbital bone removal to obtain adequate margins should be a routine part of tumor resection for these malignancies.

Accessory submandibular duct sialolithiasis identified during sialendoscopy.

We describe a unique case of a 62-year-old patient with recurrent right submandibular sialadenitis. He initially appeared to have extensive sialolithiasis of the right submandibular duct on computed tomography imaging and examination, but sialendoscopy demonstrated a normal-appearing right submandibular duct. An accessory duct posterior and parallel to the normal duct was identified at the time of sialendoscopy and was found to have extensive sialolithiasis, which required removal by both an endoscopic and intraoral technique. To the best of our knowledge, this is the first report of sialolithiasis of an accessory submandibular duct identified at the time of sialendoscopy; the other few reported cases in the literature are based primarily on findings from traditional sialography or magnetic resonance sialography. Identification of accessory salivary ducts requires intraoperative consideration of this entity during sialendoscopy. Open approaches to sialolithiasis, however, may be aided by appropriate preoperative imaging.

Epistaxis in children and adolescents with hereditary hemorrhagic telangiectasia.

OBJECTIVES/HYPOTHESIS: Our objective was to describe epistaxis onset and severity in pediatric hereditary hemorrhagic telangiectasia (HHT) patients and study the cumulative incidence of epistaxis by age of onset within each genetic subtype. STUDY DESIGN: Retrospective cohort chart review. METHODS: Charts were reviewed of patients age 0 to 18 years with a clinical or genetic diagnosis of HHT who were evaluated at a tertiary multidisciplinary HHT clinic from January 2010 to June 2016. The epistaxis severity score (ESS), a validated tool for assessing epistaxis severity, was used to assess epistaxis. Statistical analyses were conducted on the full HHT cohort as well as subgroups stratified by the HHT causative gene (HHT1 = ENG and HHT2 = ACVRL1). RESULTS: Sixty-nine pediatric subjects were identified; 60 had HHT confirmed by genetic testing, and nine (from families with known mutations) met published clinical diagnostic criteria alone. Fifty-nine (85%) had onset of epistaxis. The median age of onset of epistaxis was 5 years (interquartile range [IQR]: 2-9 years). The median ESS for the entire cohort was 1.6 (IQR: 0-2.6). The median ESS was higher in HHT1 versus HHT2 (2.3 vs. 1.1, P = .002), and age of epistaxis onset was earlier in HHT1 (3 vs. 5 years, P = .03). Sex and age were not associated with ESS. CONCLUSIONS: Epistaxis may present early in HHT, but is typically mild in the pediatric period. Severity in the pediatric population is worse in patients with HHT1. By recognizing the significance of even mild, infrequent epistaxis in a child with a family history of HHT, and understanding that not all HHT patients have epistaxis during childhood, community providers and otolaryngologist can assist in the early detection of HHT. LEVEL OF EVIDENCE: 4 Laryngoscope, 128:1714-1719, 2018.

The effects of nasal closure on quality of life in patients with hereditary hemorrhagic telangiectasia.

INTRODUCTION: Epistaxis is the most common symptom of hereditary hemorrhagic telangiectasia (HHT). Complete nasal closure is one of the treatment options for patients with severe, intractable epistaxis. In our experience, this surgery can be life changing in a positive sense; but many patients as well as their physicians understandably fear that such a procedure will diminish certain aspects of quality of life (QOL). METHODS: Case-control study of HHT patients treated at the University of Utah HHT Center of Excellence with and without nasal closure from January 2005 to January 2016. Patients were matched according to epistaxis severity. Each included patient was issued three surveys: Epistaxis Severity Score (ESS), the Pittsburg Sleep Quality Index (PSQI), and the Nasal Obstruction Symptom Evaluation (NOSE). RESULTS: After treatment, the mean PSQI and NOSE scores were not significantly different between the two groups. However, the mean ESS score in the nasal closure group was significantly lower at 1.10 compared to the severe epistaxis group with a mean score of 3.99 (P = .027). CONCLUSION: The results of this study demonstrate that nasal closure significantly improves epistaxis severity without having a significant effect on sleep or nasal obstruction as they relate to QOL. These findings suggest that nasal closure should be considered for HHT patients with chronic severe epistaxis. LEVEL OF EVIDENCE: 4.

Treatment of severe refractory epistaxis in hereditary hemorrhagic telangiectasia using a two-flap nasal closure method.

BACKGROUND: Nasal closure has been shown to effectively manage severe epistaxis refractory to other treatments in patients with hereditary hemorrhagic telangiectasia (HHT). The nasal closure procedure may be underutilized because of its surgical complexity and flap breakdown. METHODS: This work is a retrospective review of 13 HHT patients treated for severe epistaxis with nasal closure between 2005 and 2013. Operating room (OR) time, need for revision surgery, preprocedure, and postprocedure epistaxis severity score (ESS), complete blood count values, and Glasgow Benefit Inventory (GBI) questionnaire results were collected for each patient. The technique is described. We characterize a typical nasal closure patient and compare outcomes based on our experience with the traditional 3-flap closure and a simplified 2-flap nasal closure procedure. RESULTS: The average candidate for nasal closure in this series had an ESS of 7.88, hemoglobin (Hgb) of 8.3 g/dL, and received multiple transfusions, iron therapy, and cautery/coagulation procedures. Average ESS subsequent to nasal closure using the 2-flap method is 0.92 and mean GBI score is 56.3. Comparison of 5 patients who underwent the traditional 3-flap nasal closure procedure and 8 patients receiving the 2-flap nasal closure showed no significant difference in postoperative ESS or GBI metrics. Mean operating room times of the traditional and simplified methods were 3.12 hours and 1.44 hours (p = 0.0001). Mean time to first revision for 8 nasal closure patients was 21.5 months. CONCLUSION: In short-term follow-up, the 2-flap procedure showed comparable effectiveness with significantly reduced complexity and operative time compared to the traditional nasal closure method.

Complex nontuberculous mycobacterial cervicofacial lymphadenitis: What is the optimal approach?

OBJECTIVES/HYPOTHESIS: Assess the role of combined antimicrobial and surgical therapy for difficult-to-treat nontuberculous mycobacteria (NTM) lesions of the head and neck in children. STUDY DESIGN: Retrospective cohort. METHODS: Retrospective review of pediatric head and neck NTM lesions at a tertiary children's hospital from 1999 to 2012. RESULTS: Seventy-one children were diagnosed with NTM lesions. Age of presentation ranged between 7 and 204 months of age. Most patients (62%) had multiple lesions. Treatments included incision and drainage, curettage, antibiotics, excision, and any combination of surgery and antibiotics. Upon initial presentation, the most common treatment was surgical excision alone (n = 34) with a high complication rate (50%). In 18 cases, patients were initially treated with a combination of antibiotics and surgical excision due to the extent or location of the lesion(s). Complication rate in these patients was also high (67%). The most common complications in surgically excised NTM lesions included temporary or persistent facial nerve dysfunction (24.6%), poor wound healing/scarring (10.8%), and Frey's syndrome (6.2%). CONCLUSIONS: Surgical excision with or without medical therapy for NTM cervicofacial lymphadenitis in high-risk regions commonly resulted in marginal mandibular nerve dysfunction (24.6%). Postoperative facial nerve weakness generally resolved within a year. High rates of complications and a lack of proven best approaches suggest tailoring the approach to address the potential risks in that particular patient based on location and severity. LEVEL OF EVIDENCE: 4 Laryngoscope, 126:1677-1680, 2016.

An evaluation of the severity and progression of epistaxis in hereditary hemorrhagic telangiectasia 1 versus hereditary hemorrhagic telangiectasia 2.

OBJECTIVES/HYPOTHESIS: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant vascular dysplasia whose hallmark symptom is spontaneous recurrent epistaxis. Two major genetic subtypes of this syndrome are HHT1 and HHT2. Severity of epistaxis ranges from occasional low-volume bleeding to frequent large-volume hemorrhage. This study evaluated the severity and progression of epistaxis in HHT1 versus HHT2. STUDY DESIGN: Retrospective cohort study. METHODS: A retrospective chart review was performed for 183 genotyped HHT patients seen at our center from 2010 to 2013. Data collected included epistaxis severity score (ESS), age of epistaxis onset, number and type of treatments, age at which treatments were sought, complete blood count values, ferritin, number of telangiectases, blood transfusions, iron therapy history, and patient demographics. RESULTS: 115 subjects with HHT2 were compared to 68 with HHT1. Subjects with HHT2 had a higher ESS compared to HHT1 (P = .043) and a later age of onset of epistaxis (P = .005). HHT2 subjects were more likely to use oral iron (P = .032) and were more likely to seek interventions to control their epistaxis (P = .029). CONCLUSIONS: HHT2 is associated with more severe epistaxis and a subsequent higher rate of interventions, requiring more aggressive therapy as compared to HHT1. LEVEL OF EVIDENCE: 4.

Tumor Biomarkers in Spindle Cell Variant Squamous Cell Carcinoma of the Head and Neck.

OBJECTIVE: To determine biomarkers of recurrence and survival in patients with spindle cell variant squamous cell carcinoma (SpSCC) of the head and neck. STUDY DESIGN: Retrospective case control study. SETTING: Tertiary academic center. SUBJECTS AND METHODS: Thirty-two SpSCC patients (mean age, 68.8) between 1987 and 2009 were identified and reviewed. A tissue microarray (TMA) was constructed from tumor specimens. Tumor biomarkers under study included p16, epidermal growth factor receptor (EGFR), p53, EZH2, cyclin D1, CD104, HGFa, p21, and cMET. An additional TMA was constructed from patients with non-SpSCC oral cavity squamous cell carcinoma for comparative purposes. The main outcomes were overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS). RESULTS: In the SpSCC cohort, tumors positive for cMet had worse OS (P < .001). Patients positive for cMet (P = .007), cyclin D1 (P = .019), and p16 (P = .004) had worse DSS. Recurrence-free survival was also worse in patients with tumors positive for cMet (P = .037), cyclin D1 (P = .012), and p16 (P < .001). Compared with the oral cavity cohort, there was a significantly larger proportion of patients in the SpSCC group with tumors staining positive for cMet and a lower proportion of tumors positive for cyclin D1. CONCLUSION: cMet, cyclin D1, and p16 are predictive tumor biomarkers for risk of recurrence and worse DSS in patients with SpSCC.

Diagnosis of asthma: clinical assessment.

BACKGROUND: Asthma is a common condition that presents with varied symptomatology and exam findings. The diagnosis of asthma is made through a combination of clinical assessment and diagnostic testing. METHODS: A literature review was conducted through PubMed, focusing on systematic reviews and practice parameters. The highest-quality studies and those including the highest number of patients were included. References were reviewed for additional relevant articles. RESULTS: Patients with asthma present with the symptoms of cough, dyspnea, and wheezing. The physical exam can demonstrate hyperinflation, wheezing, and increased work of breathing, but most patients will present with a normal pulmonary exam because they are between episodes. The symptoms and examination of patients with asthma varies greatly from patient to patient and within the same patient over time. The diagnosis of asthma in the pediatric population may be more difficult because the classic symptoms may not be present in many of those patients. CONCLUSION: The diagnosis of asthma is made in the setting of clinical history, physical exam, and diagnostic testing. The astute physician will rely on all 3 of these factors when making the diagnosis.

The association between allergy and chronic rhinosinusitis with and without nasal polyps: an evidence-based review with recommendations.

BACKGROUND: The relationship between allergy and chronic rhinosinusitis (CRS) remains ill-defined and controversial. The association between the 2 is unclear, making an evidence-based decision of whether to evaluate and treat allergies in CRS patients difficult. The purposes of this systematic review are to (1) examine the relationship between allergy and CRS without nasal polyps (CRSsNP), (2) examine the same for allergy and CRS with nasal polyps (CRSwNP), and (3) recommend evaluation and treatment based on the evidence. METHODS: A structured literature search was performed to identify articles examining the link between allergy and CRSsNP and CRSwNP. Pertinent articles were examined for evidence for an association between allergy and CRSsNP and/or CRSwNP. RESULTS: A total of 24 articles were found that met the inclusion criteria; 18 articles examined the relationship between allergy and CRSwNP, with 10 articles showing an association, 7 articles showing no association, and 1 article showing a possible association. Nine articles examined the relationship between allergy and CRSsNP, with 4 articles showing an association and 5 articles showing no association. Four studies directly compared the role of allergy in CRSwNP and CRSsNP, and, again, the results were mixed. No articles examined the outcomes of CRSsNP or CRSwNP following allergy treatment. CONCLUSION: The role of allergy in CRSwNP and CRSsNP continues to be controversial, with the level of evidence poor. Based on the available data, the recommendation is that allergy testing and treatment are an option in CRSwNP and CRSsNP.

Tympanoplasty with intact canal wall mastoidectomy for cholesteatoma: long-term hearing outcomes.

OBJECTIVES/HYPOTHESIS: To review long-term hearing results after intact canal wall mastoidectomy with tympanoplasty for treatment of cholesteatoma and to identify factors associated with improved hearing outcomes. STUDY DESIGN: A retrospective analysis of all cases of cholesteatoma treated with intact canal wall mastoidectomy at a single institution by the senior author over a period of 9 years, for which at least 2 years of follow-up data exist. METHODS: Patient and disease information was collected retrospectively and analyzed. RESULTS: There were 148 patients with 156 affected ears treated and followed for a median of 5.3 years (interquartile range, 3.6-7.4 years). The majority of the operations (144/156, 92%) were staged. Hearing data were available for 150 ears. The overall postoperative mean air-bone gap was ≤ 20 dB in 64% of patients. This was maintained long term in most patients, with 59% of patients still with an air-bone gap ≤ 20 dB at a median follow-up of 5.3 years. The presence of an intact stapes did not affect initial hearing outcomes, but the group with an intact stapes had improved long-term hearing results compared to those without an intact stapes (71% vs. 42% air-bone gap ≤ 20 dB, P < .001). The presence of a malleus handle also led to superior long-term hearing outcomes (72% vs. 48% air-bone gap ≤ 20 dB, P = .005). CONCLUSIONS: Long-term hearing results from intact canal wall mastoidectomy with tympanoplasty are excellent, with the majority of patients maintaining a small air-bone gap long term. The presence of a stapes and/or malleus handle confers improved long-term hearing outcomes.

Tympanoplasty with intact canal wall mastoidectomy for cholesteatoma: long-term surgical outcomes.

OBJECTIVE: With different mastoidectomy approaches available to the surgeon for treatment of cholesteatoma, we review long-term outcomes of intact canal wall (ICW) mastoidectomy with tympanoplasty. STUDY DESIGN: Case series with chart review. SETTING: Academic medical center. SUBJECTS AND METHODS: All cases of cholesteatoma treated with ICW mastoidectomy by the senior author over a period of 9 years for which at least 2 years of follow-up data exist. Patient and disease information was collected retrospectively and analyzed. RESULTS: One hundred forty-eight patients with 156 affected ears were treated and followed for a median of 5.3 years (range, 2.1-14.8). The majority of the operations (144/156, 92%) were staged. Of those that were staged, 51/144 (35%) had residual cholesteatoma at the second stage. Thirteen patients (8%) had recurrence of their cholesteatoma, of which 6 required a subsequent canal wall down (CWD) mastoidectomy. CONCLUSIONS: ICW mastoidectomy with tympanoplasty continues to be a successful treatment for cholesteatoma. We found a substantial residual rate at the second stage, justifying the necessity of staging in most cases. Recurrence rate of cholesteatoma using this technique is low, as is the progression to CWD mastoidectomy.

Perioperative strategies to improve sinus surgery outcomes in patients with cystic fibrosis: a systematic review.

OBJECTIVES: Review the literature for intraoperative techniques and postoperative practices after functional endoscopy sinus surgery (FESS) that may improve outcomes in patients with cystic fibrosis (CF). DATA SOURCES: PubMed and the Cochrane Library. REVIEW METHODS: A systematic review of the literature was performed. Articles from 1990 to 2012 were searched using the terms sinus surgery and cystic fibrosis with studies limited to the English language and human subjects. Abstracts were reviewed to identify relevant original manuscripts. Bibliographies of relevant articles were examined to identify additional manuscripts. RESULTS: The initial PubMed search identified 169 articles. One additional article was identified through the Cochrane Library. After reviewing the abstracts, 41 selected studies were examined in further detail, and 22 articles were ultimately selected for suitability for this review. The bibliographies of these articles were reviewed and no additional articles were identified. Perioperative strategies included postoperative medical therapies, intraoperative techniques and image guidance, intranasal corticosteroid injection, dornase alfa, gene therapy, and second-look procedures. Most studies were limited to case series with relatively small numbers of patients. Very few randomized controlled studies were identified. CONCLUSION: Despite the prevalence of recurrent sinonasal disease after FESS in patients with CF, evidence for definitive perioperative management in this population is lacking. Most recommendations are based on small case series. Multicenter studies to evaluate perioperative strategies that improve FESS outcomes in patients with CF are warranted.

Assessment of otolaryngic knowledge in primary care residents.

OBJECTIVES: (1) Determine the amount of exposure to otolaryngology in medical training of non-otolaryngology residents. (2) Evaluate the general otolaryngic knowledge in these residents. STUDY DESIGN: Cross-sectional survey. SETTING: Academic medical center. SUBJECTS AND METHODS: A 10-question multiple-choice quiz was given to residents in family practice, pediatrics, emergency medicine, and internal medicine during scheduled educational conferences. Residents were also asked if they ever participated in an otolaryngology rotation during medical school or residency. Medical students and otolaryngology residents completed the quiz to act as controls. RESULTS: A total of 98 examinations were analyzed (49 non-otolaryngology residents, 10 otolaryngology residents, and 39 second-year medical students). Only 24% of the non- otolaryngology residents had an otolaryngology rotation during medical school. The same amount (24%) had a rotation during residency. The average percentage correct on the quiz was 48%, 56%, and 92% for medical students, non-otolaryngology, and otolaryngology residents, respectively (P < 0.05). Questions with surprising results included one with an endoscopic image of the middle turbinate and examinees asked to identify the structure (non-otolaryngology residents = 18% correct). A laryngectomy stoma was shown and participants asked what would happen if the stoma was occluded for 10 minutes (non-otolaryngology residents = 20% correct). CONCLUSION: In this sample of non-otolaryngology residents, a minority experienced a clinical rotation in otolaryngology during medical school or residency. This nonvalidated questionnaire also suggested significant deficiencies in basic otolaryngic knowledge in these residents. Identifying mechanisms to improve exposure to otolaryngology in the medical training curriculum is needed.

Treatment of oral cavity venous malformations with the Nd:YAG laser using the underwater technique.

Mucosal involvement of venous malformations can cause bleeding, pain, and functional impairment. Treatment options include surgery, sclerotherapy, or laser therapy. Neodymium:yttrium aluminum garnet (Nd:Yag) laser therapy has been used to treat mucosal disease, but few studies have focused purely on the oral cavity. We present a retrospective review of 4 patients (5 subsites) with oral cavity venous malformations treated with the Nd:YAG laser using an underwater technique. Photographs of the venous malformations before and after treatment were evaluated by 2 blinded physicians. A visual analog scale was used to rate the treatment. The medical record was reviewed to assess change in symptoms and to note complications. Four sites were rated as having "significant improvement" and 1 site as "some improvement." Our study demonstrates that the Nd:YAG laser can be a feasible option in the treatment of venous malformations of the oral cavity.

Types of rhinitis.

Rhinitis is a familiar disorder affecting up to 20% of the general population. Chronic rhinitis can be broadly classified into allergic, infectious, or nonallergic or noninfectious, which are distinguished mainly by a careful history and allergy testing. The pathophysiology of nonallergic rhinitis likely involves a combination of inflammatory and neurogenic mechanisms that are poorly understood. Treatment involves avoiding the offending agent, when possible, and using appropriate medications to control the patient's predominant symptoms.

Clinical and pathologic predictors of recurrence and survival in spindle cell squamous cell carcinoma.

OBJECTIVE: To determine clinicopathologic predictors of recurrence and survival in patients with spindle cell squamous cell carcinoma (SpSCC). STUDY DESIGN: Historical cohort study. SETTING: Tertiary care hospital. SUBJECTS AND METHODS: Forty-eight patients (mean age, 65.2 years; 35 men, 13 women) who underwent definitive treatment for pathologically confirmed SpSCC between 1987 and 2009 were identified and reviewed. The main outcome measures were time to recurrence and overall survival, while controlling for clinical and pathologic parameters (age, sex, TNM classification, stage, tumor subsite, smoking status, treatment modality, margin status). RESULTS: Of 48 patients, there were 25 oral cavity, 15 laryngeal, 7 oropharyngeal, and 1 maxillary sinus tumors. Treatment included surgery in 32, radiation in 9, and concurrent chemoradiation in 7 patients. The 3-year overall survival for the cohort was 62% with a median follow-up of 59 months; 52.1% (25/48) of patients developed a recurrence, and 88% (22/25) recurred locally or locoregionally. Recurrence occurred within 2 years in 72% (18/25) of patients. Age, sex, initial T and N classification, overall stage, tumor subsite, smoking status, treatment modality, and margin status were not predictive of recurrence or overall survival. CONCLUSION: Patients with SpSCC are at high risk of developing locoregional recurrence, but no measured clinical or pathologic parameter was predictive of survival. Although overall survival is similar to that of patients with conventional SCC, closer follow-up should be considered in these patients to allow earlier detection and treatment of these locally aggressive tumors.

Cricotracheal resection with hilar release for pediatric airway stenosis.

OBJECTIVE: To determine the effectiveness of cricotracheal resection and hilar release for high-grade, long-segment airway stenosis. DESIGN: We identified 16 patients who underwent cricotracheal resection and hilar release, performed from January 1, 2004, through December 31, 2008, and conducted a retrospective review, emphasizing preoperative findings, operative technique, postoperative course, and results. Complete data sets were available for all patients. SETTING: Tertiary care children's hospital. PATIENTS: The study population comprised 16 patients younger than 18 years who underwent cricotracheal resection and hilar release performed by a thoracic airway team. All patients had high-grade, long-segment subglottic stenosis or severe, long-segment tracheomalacia. INTERVENTION: Cricotracheal resection with hilar release. MAIN OUTCOME MEASURES: Decannulation rate and dehiscence rate. RESULTS: Of the 16 patients, 15 were successfully decannulated. The one patient who was not decannulated remained ventilator dependent and has regained speech. There were no incidents of anastomotic dehiscence. CONCLUSION: Cricotracheal resection with hilar release is a novel and effective way to approach the problem of severe airway stenosis.