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Posterior Glottic Stenosis (Scarring) - Surgical treatment with video - Clinical case example

last modified on: Tue, 01/09/2024 - 16:24

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Case Example

~ 50 yo male intubated for 14 days one year before evaluation in our clinic. Progressive airway obstruction after extubation resulted in a tracheotomy done elsewhere 6 months before presentation in place (Montgomery cannula)

 

Limited glottis opening still permitting capping of the cannula for much of the day, requiring uncapping for exertion and sleep.

Transnasal flexible laryngoscopy exam: limited glottis opening (deep inspiration inspiration):

Examination in clinic

View of subglottis through tracheostome

 
 

Examination under general anesthesia - immobile arytenoids relative to cricoid (fixed) = Bogdasarian type IV

Bilateral partial arytenoidectomy with resection of interarytenoid and EPAF (Endoscopic Postcricoid Advancement Flap)

  • successful in deepening posterior glottic aperture ('the respiratory glottis') but without success in the interposition of the mucosal flap
  • (did not retain viability) - treated with subsequent surgery detailed above - with impression that the removal of the interarytenoid muscle in performing the 'EPAF' was helpful in improving the airway despite failure of the mucosal flap

References

Damrose EJ1, Beswick DM2.Repair of Posterior Glottic Stenosis with the Modified Endoscopic Postcricoid Advancement Flap.Otolaryngol Head Neck Surg. 2016 Mar;154(3):568-71. doi: 10.1177/0194599815622626. Epub 2016 Feb 9.