Functional outcomes after transoral CO2 laser treatment for posterior glottic stenosis: a bicentric case series

Abstract

Purpose The aim of this study is to evaluate functional outcomes in terms of decannulation rate and quality of life of patients affected by PGS (Grades I–IV) treated only by transoral CO2 laser microsurgery (TOLMS) in two tertiary centers. Methods An observational retrospective study was carried out, enrolling 22 patients affected by PGS who were treated by a transoral approach at two tertiary referral centers. Surgical treatment included TOLMS with tailored laser resection of the scar tissue combined with posterior cordotomy, resurfacing of the raw area with mucosal microflap, or placement of a Montgomery T-tube or Keel stent. All patients were evaluated and staged preoperatively and postoperatively, at least 6 months after the surgery. Functional outcomes were objectively evaluated by the Airway-Dysphonia-Voice-Swallowing (ADVS) staging system, Voice Handicap Index-30 (VHI-30), and Eating Assessment Tool-10 (EAT-10) questionnaires. Results Quality of life significantly improved as measured by the VHI-30 questionnaire with a median variation of − 31.0 (p = 0.003), the EAT-10 with a median variation of − 4.0 (p = 0.042), and the ADVS with a median variation of − 3.5 (p < 0.001). No significant changes were observed in swallowing scores. We were able to decannulate 7 of 9 patients (almost 80%) with previous tracheotomy. Conclusion In conclusion, even if there is still no general agreement on an exact therapeutic algorithm to treat PGS, our results confirm that transoral surgery, in terms of scar tissue removal, combined in selected patients with posterior cordotomy and pedicled local flaps and/or placement of stents, represents a safe and effective surgical approach even for more severe PGS.

Bilateral selective laryngeal reinnervation in patients with bilateral vocal cord palsy

“…Failure to recognise interarytenoid scarring or cricoarytenoid joint fixation will result in inappropriate patient selection and consequently poor results after BSLR 22 . In cases of interarytenoid scar or cricoarytenoid joint fixation, an endoscopic approach (such as arytenoidectomy/posterior cordotomy) may be indicated 7 , 23 .…”

“…The inclusion criteria for BSLR were diagnosis of BVFP for more than 6 months (23,8,84,12, and 96 months, respectively) with no sign of reinnervation of the PCA muscles detected at pre-operative evaluation and good health status (patients were fit and well, and no neuromuscular pathologies or respiratory diseases were present). Two of 5 patients were tracheostomy dependent when referred to our team; tracheostomy was performed at other ENT departments due to acute respiratory distress.…”