Endoscopic Posterior Rotation Flap for Posterior Glottic Insufficiency

Scoping Review of Surgical Rehabilitation of Post Intubation Phonatory Insufficiency

“…PCR, either endoscopic or open, functions by removing a small vertical strip of cricoid cartilage followed by re‐approximation of the lateral wound edges. This effectively decreases interarytenoid distance, thus increasing subglottic pressure generation and thereby improving vocal projection 8,10 . In our review, most PCR patients had substantial improvements in vocal quality both subjectively assessment and by patient reported outcomes measures (Table I).…”

“…1): 51 were excluded as duplicates, and 38 were reviewed for inclusion. Twenty‐nine were eliminated based on inclusion criteria and nine 1,3,8–14 remained for full review (Table I). Most of the articles were from the United States (7/9), one from Ireland, and one from Chile.…”

“…Endoscopic local mucosal flaps carry significantly less morbidity. Graft donor locations reported were pharyngoepiglottic, aryepiglottic, and arytenoid mucosa 3,10,14 . In this technique, endoscopic grafts are lifted, repositioned, and sutured into the posterior mucosal defect.…”

“…Both free and local tissue flaps were utilized in the selected studies. 3,9,10,14 In the one case of free mucosal grafting, buccal tissue was grafted onto a resurfaced interarytenoid region via open transcervical approach. 9 Although the technique is associated with more initial surgical morbidity, the patient reported had favorable a voice outcome and the graft appeared healthy 1-2 years post-surgery.…”

“…Vocal outcomes were by-and-large favorable, though some patients had a persistent raspy voice likely from the discontinuity caused by grafted mucosa along the free margin of the VF. 10,14 Like the free buccal graft, local flaps allow for targeted correction of medial arytenoid mucosa deficiency and vocal process troughs/divots without substantially increasing the risk of airway compromise. Similar techniques have been used to correct posterior glottic stenosis (PGS).…”