return to: Laryngeal Surgery (Benign Disease) Protocols

Etiology

1. Acute swelling of the supraglottic larynx is most often bacterial (supraglottitis / epiglottitis) or traumatic
2. Chronis swelling and edema of the supraglottic larynx is also common after irradiation (Mendenhall 2008)
3. Chronic scarring of the supraglottic larynx is less common and has been reported to result from:
   1. prolonged orotracheal intubation, instrumentation of or trauma to the supraglottic larynx
   2. autoimmune disorders (pemphigoid, SLE, Wegeners granulomatosis, scarcoidosis, relapsing polychondritis)
   3. cautic ingestion
   4. gastro-esophageal reflux disease (Krishna 2006)

Management

1. Dependent on etiology -
   1. Medical management (steroids/immunosupressants)
   2. Surgical management (tracheotomy, endoscopic laser resection, supraglottic laryngectomy, thyrotomy or laryngofissure with placement of a keel or stent) (Montgomery 1968)

Laryngeal stents

1. Used to keep airway lumen patent after surgical dilation/expansion, reconstruction or trauma
2. Types of stents: Keel, Montgomery, Silastic sheet, Aboulker 
3. Complications: granulation tissue formation, occlusion, ulceration, infection 

References

Veivers D and Laccourreye: Supracricoid partial laryngecotmy for severe laryngeal stenosis. Arch Otolaryngol Head and Neck Surgery/vol 126, May 2000 pp663-664 

Krishna PD and Malone JP: Ioslated adult suprglottic stenosis: surgical treament and possible etiologies. American Journal of Otolaryngology-Head and Neck Medicine and Surgery 27 (2006) 355-357 

Montgomery WW. The surgical management of supraglottic and subglottic stenosis. Ann Otol Rhinol Laryngol 1968; 77(3):534-46 

Mendenhall WM, Hinerman RW, Amdur RJ et al: Chapter 44 "Larynx" pp 993-994 'Sequelae of Treatment' in Principles and Practice of Radiation Oncology. 5th edition 2008 Lippincott Philadelphia