The cricoid split: an alternative to paediatric tracheostomy.

Advances in neonatal intensive care has increased the salvage rate of preterm infants. Many of these require ventilatory support for Respiratory Distress Syndrome or other cardiopulmonary problems. This has lead to an apparent increase in the incidence of acquired subglottic stenosis with difficulties in extubation. In the past, after several attempts at extubation, a tracheostomy is performed with definitive therapy instituted later. Since the first report of the Anterior Cricoid Split (ACS) in 1980, the extubation success rate of all centres average about 77%. The ACS is thus an alternative to tracheostomy, provided it is done for the correct indications and strict selection criteria are applied. How it works is still unclear, but certainly it achieves laryngotracheal decompression with relief of tension and oedema of the cricoid ring. The original indication was for cases of non-fibrous subglottis stenosis; these have now been expanded in recent years to include children with glottic pathology and with a tracheostomy in situ. The availability of excellent intensive care facilities is a prerequisite to doing an ACS; otherwise a tracheostomy is a safer option.