Autologous cricoid graft reconstruction of complete transglottic laryngeal atresia: Case report.

INTRODUCTION: Improved survival in congenital high airway obstruction syndrome (CHAOS) has shifted management toward definitive airway reconstruction and functional airway independence. However, severe cartilaginous laryngeal atresia may distort normal laryngotracheal anatomy and limit conventional reconstructive approaches. We describe an anatomy-specific reconstruction using obstructing dysplastic cricoid cartilage as an autologous posterior graft. CLINICAL FINDINGS: A male infant with CHAOS underwent EXIT-to-tracheostomy at 32 weeks' gestation. At age three, airway evaluation demonstrated complete Grade IV transglottic laryngeal atresia with fused vocal folds, severe cricoid dysplasia, megatrachea, tracheobronchomalacia, and active lower-airway inflammation. Definitive reconstruction was delayed for pulmonary optimization. THERAPEUTIC INTERVENTION AND OUTCOMES: Double-stage laryngotracheoplasty with anterior and posterior costal cartilage grafting was initially planned. Intraoperative exposure revealed a profoundly abnormal cricoid framework with a fixed obstructing anterior cartilaginous segment and deficient posterior airway. The anterior cricoid was resected during extended partial cricotracheal resection and repurposed as a 10 × 4 × 3-mm keystone-shaped posterior autologous graft in conjunction with laryngofissure, glottic recreation, and prolonged suprastomal stenting. The graft demonstrated complete incorporation after 6.5 months. Following one postoperative balloon dilation, the patient was successfully decannulated 13 months after reconstruction. Surveillance bronchoscopy demonstrated durable airway patency without restenosis. CONCLUSION: Complex congenital laryngotracheal anatomy may require individualized adaptation of established reconstructive techniques. Repurposing obstructing dysplastic cricoid cartilage for posterior airway augmentation provided simultaneous relief of anterior obstruction and posterior expansion, with durable airway patency and successful decannulation validating this anatomy-specific approach.