Glottic Stenosis: An Anatomic Analysis and New Treatment With a Self-Retaining Interarytenoid Spring

Abstract

Introduction: Endotracheal (ET) intubation is a common cause of acquired glottic stenosis. Severe cases often require an irreversible arytenoidectomy/cordectomy, which typically results in poor voice quality. Adult human cadaver larynges were studied to gain insights about ET tube–induced posterior glottic injuries, hoping to create a less invasive remedy. Study Design: Human cadaver investigation and case reports. Methods: Microlaryngeal assessments were done on 10 human cadaver larynges (5 men, 5 women) with and without ET tubes. After supracricoid soft tissue resection, measurements were obtained, including the distance between the outer diameter of the ET tube and the medial aspect of the cricoarytenoid joint facet. Additionally, measurements of the circumferential arc of differently sized ET tubes were made alongside both cricoarytenoid joint capsules. This information was used to design a silastic stent that would function as a self-retaining interarytenoid spring to treat posterior glottic stenosis in 5 patients. Four of 5 patients included in the clinical study were tracheotomy dependent, primarily because of glottic stenosis. The human surgical technique is described in detail. Results: The shortest distance between the outer diameter of the ET tube to the medial cricoid facet averaged 5.02 mm in men and 3.62 mm in women. On the basis of the diameter of the intralaryngeal component of the initially round stent, and the position of the cricoarytenoid joint facets, the interarytenoid spring would have a subtended arc between 110° and 175°. These data helped fashion parameters for modifying a conventional T-tube to form a new self-retaining silastic interarytenoid spring. The first 5 human cases have been successful, allowing effective tracheotomy tube decannulation and excellent voice quality. Conclusions: The anatomic investigation herein provided key insights into ET tube–induced glottic stenosis and facilitated a new straightforward procedure to surgically improve the airway yet preserve excellent vocal function in patients with acquired glottic stenosis. Level of Evidence: NA

Type I posterior glottic stenosis: an endoscopic approach

“…3 PGS type I is the rarest type and is frequently caused by intubation injury to interarytnoide tissue that causes pressure necrosis, mucosal breakdown, formation of granulation tissue, and subsequent scarring. 1,7 Laryngotracheal trauma during intubation should be minimized in pediatric patients.…”

“…Type I posterior glottic stenosis (PGS) is most prevalent as a result of prolonged endotracheal (ET) intubation. 1 The main reasons to post-intubation stenosis are: intubation trauma and injuries caused by ET tube pressure. Due to oro-pharyngeal curvature the ET tube, at all times, lies in the posterior glottis.…”

Surgical Treatment Strategies for Laryngeal Chondrosarcomas: A Single Institution Investigation

“…He was reconstructed with a large aortic homograft, and a modified T-tube stent. 11 He is decannulated (B,D) and has an excellent supraglottic sound source similar to a patient who undergoes a supracricoid partial laryngectomy. Note that the right arytenoid cartilage is affixed to the thyroid lamina (B).…”

“…(A,C) He underwent an extensive transmural right‐sided transcervical tumor removal along with a portion of the inner table tumor of the left. He was reconstructed with a large aortic homograft, and a modified T‐tube stent 11 . He is decannulated (B,D) and has an excellent supraglottic sound source similar to a patient who undergoes a supracricoid partial laryngectomy.…”

Pathological changes of larynx in inhalational thermal injury causing laryngeal stenosis based on a canine model

“…Steven M. et al [16] reported that intubation is the most commonly observed etiology of acquired laryngeal stenosis at present, and for inhalational thermal injury, Allison Reid et al [17] suggested that it is di cult to distinguish laryngeal stenosis that arise from intubation or inhalational injury. The study conducted by Bruce Benjamin et al [18] revealed that granuloma on the vocal process of the posterior glottis, which proceeds from granulation tissues, is one of the main sequelae of intubation.…”