Management of subglottic stenosis with the “Maddern procedure”: long term follow‐up outcomes
Author(s)
Type
Journal Article
Abstract
Objective
Full-thickness resection and skin grafting of the laryngotracheal junction, the “Maddern Procedure,” can be used to treat patients with recalcitrant laryngotracheal stenosis. We report the long-term surgical outcomes of this procedure.
Methods
A consecutive series of 27 females with idiopathic, iatrogenic, or vasculitic subglottic stenosis who underwent the Maddern procedure between 2012 and 2023 were retrospectively reviewed. Airway outcome was assessed using the Modified Medical Research Council Dyspnea (mMRC) Scale. Secondary outcomes included voice, swallowing, mucus management, complications, and the need for subsequent airway surgery.
Results
Most patients had idiopathic subglottic stenosis (n = 20, 74.1%), followed by vasculitic (n = 4, 14.8%) and intubation-related (n = 3, 11.1%) etiologies. Patients had an average of 7.3 (SD 3.4) endoscopic procedures before undergoing the Maddern procedure. Mean pre-Maddern inter-treatment interval was 7.5 months (SD 3.4). The median follow-up was 6.6 years (interquartile range 0.75–11.3). The mMRC dyspnea scale improved from 2.7 (SD 0.73) to 0.52 (SD 0.85). The five-year recurrence-free rate was 63%. It differed between etiologies, ranging from 83% for idiopathic stenosis to 67% for intubation-related and 0% for vasculitis-related stenoses. During the first 4 years after Maddern, 67% of patients reported daily cough and the need to use nebulizers regularly.
Conclusion
The Maddern procedure is an effective and durable option for patients with idiopathic subglottic stenosis. Careful screening of patients with presumed idiopathic subglottic stenosis for possible underlying auto-immune conditions remains important when considering patients for this procedure.
Level of Evidence
Level 4.
Full-thickness resection and skin grafting of the laryngotracheal junction, the “Maddern Procedure,” can be used to treat patients with recalcitrant laryngotracheal stenosis. We report the long-term surgical outcomes of this procedure.
Methods
A consecutive series of 27 females with idiopathic, iatrogenic, or vasculitic subglottic stenosis who underwent the Maddern procedure between 2012 and 2023 were retrospectively reviewed. Airway outcome was assessed using the Modified Medical Research Council Dyspnea (mMRC) Scale. Secondary outcomes included voice, swallowing, mucus management, complications, and the need for subsequent airway surgery.
Results
Most patients had idiopathic subglottic stenosis (n = 20, 74.1%), followed by vasculitic (n = 4, 14.8%) and intubation-related (n = 3, 11.1%) etiologies. Patients had an average of 7.3 (SD 3.4) endoscopic procedures before undergoing the Maddern procedure. Mean pre-Maddern inter-treatment interval was 7.5 months (SD 3.4). The median follow-up was 6.6 years (interquartile range 0.75–11.3). The mMRC dyspnea scale improved from 2.7 (SD 0.73) to 0.52 (SD 0.85). The five-year recurrence-free rate was 63%. It differed between etiologies, ranging from 83% for idiopathic stenosis to 67% for intubation-related and 0% for vasculitis-related stenoses. During the first 4 years after Maddern, 67% of patients reported daily cough and the need to use nebulizers regularly.
Conclusion
The Maddern procedure is an effective and durable option for patients with idiopathic subglottic stenosis. Careful screening of patients with presumed idiopathic subglottic stenosis for possible underlying auto-immune conditions remains important when considering patients for this procedure.
Level of Evidence
Level 4.
Date Issued
2026-01-01
Date Acceptance
2025-07-21
Citation
The Laryngoscope, 2026, 136 (1), pp.243-250
ISSN
0023-852X
Publisher
Wiley
Start Page
243
End Page
250
Journal / Book Title
The Laryngoscope
Volume
136
Issue
1
Copyright Statement
© 2025 The Author(s). The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
10.1002/lary.70032
Subjects
airway reconstruction
airway stenosis/reconstruction
airway stenosis-clinical
otolaryngology
otorhinolaryngology
Publication Status
Published
Article Number
lary.70032
Date Publish Online
2025-08-20