A novel surgical treatment for posterior glottic stenosis using thyroid ala cartilage – A case report and literature review

Posterior glottic stenosis (PGS) describes a laryngeal disorder in which worsening degrees of scarring limit abduction of the vocal folds and/or arytenoids. It can be congenital or acquired. Generally, the acquired form is the result of chronic endotracheal tube trauma to the posterior larynx. Sympt...

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Bibliographic Details
Published in:International journal of pediatric otorhinolaryngology 2018-11, Vol.114, p.129-133
Main Authors: Gaffey, Megan M., Sun, Ravi W., Richter, Gresham T.
Format: Article
Language:English
Subjects:
Airway
Airway Extubation - adverse effects
Airway Obstruction - complications
Cicatrix - complications
Constriction, Pathologic - complications
Glottis - pathology
Glottis - surgery
Humans
Infant
Intubation, Intratracheal - adverse effects
Laryngoplasty - methods
Laryngoscopy - methods
Laryngostenosis - diagnosis
Laryngostenosis - surgery
Laryngotracheoplasty
Male
Posterior glottic stenosis
Subglottic stenosis
Thyroid Cartilage - transplantation
Trachea - surgery
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Summary:Posterior glottic stenosis (PGS) describes a laryngeal disorder in which worsening degrees of scarring limit abduction of the vocal folds and/or arytenoids. It can be congenital or acquired. Generally, the acquired form is the result of chronic endotracheal tube trauma to the posterior larynx. Symptoms of acquired PGS usually begin four to eight weeks after extubation, and present as gradually worsening stridor and shortness of breath as the laryngeal obstruction becomes more severe. Without intervention, PGS can cause total obstruction and respiratory failure. The mainstay of treatment for PGS is surgery. We present a case in which an infant patient with PGS was treated with a posterior cricoid split and insertion of a thyroid ala graft. The graft was bolstered in place with an appropriately-sized endotracheal tube during a six-day period of postoperative intubation. We report this as a novel surgical approach, as a literature review did not uncover that this technique has been previously described. Our patient has had excellent airway and voice outcomes. His swallow outcomes have been difficult to assess, as the patient has shown signs of global delay.
ISSN:0165-5876
1872-8464
DOI:10.1016/j.ijporl.2018.07.025