Rebuilding the airway: Integrated surgical management of severe subglottic stenosis.

Subglottic stenosis is a rare but potentially life-threatening condition in pediatric patients. We report the case of a 13-year-old male with a history of neonatal hypoxia, prolonged intubation, and multiple failed airway surgeries, presenting with a Myer-Cotton grade IV subglottic stenosis. Imaging and endoscopic evaluation revealed complete subglottic obstruction, absence of the anterolateral cricoid arch, and preoperative apparent absence of either vocal folds. A complex laryngotracheal reconstruction was performed, involving complete laryngofissure, placement of a posterior costal graft, and a horizontally oriented anterior costal graft to address the extensive anterolateral cricoid defect. Additionally, absorbable pediatric osteosynthesis plates were used in a novel fashion to stabilize the lateral laryngeal walls, providing structural support without permanent materials. Postoperative evolution was favorable, with airway patency and spontaneous ventilation achieved through a Montgomery T-tube. This case illustrates the importance of individualized surgical strategies in managing severe airway stenosis and proposes a novel combination of reconstructive techniques for complex pediatric cases with extensive laryngeal deformities.