Aseptic necrosis of the cricoid: a complication of tracheal intubation

Abstract

Necrosis of the cricoid is a rare complication of tracheal intubation. Almost all cases previously reported were purulent. A 25-year-old man presented with a respiratory distress, two months after 2 days of tracheal intubation. The posterior larynx was the site of a major inflammation with fixity of the arytenoids. After an emergency control of the airway in the acute phase, a posterior cricoid split with widening by a laryngeal stent was performed for treatment of sequelae. Evolutional data from clinical examinations, direct fiberoptic laryngoscopy, CT scan, respiratory function tests, and pathology are described. Successive phases of latency, then acute manifestations, then sequelae can be distinguished. The work-up did not reveal any sign in favor of a septic necrosis. A physiopathologic hypothesis is suggested, explaining the necrosis as an ischemic one, due to destruction of the internal perichondrium vascular network of the cricoid.