Management of posterior glottic stenosis using the Combined Glottic Reconstruction procedure

Nouraei, S.A.R.; Dorman, Edwin B.; Vokes, David E.

doi:10.1111/coa.13154

Cited by 3 publications

(5 citation statements)

References 3 publications

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“…Montgomery et al [ 12 ] firstly described a postcricoid mucosal advancement flap (PCMAF) through a laryngofissure. More recently, combined glottic reconstruction (CGR) [ 15 ] has been described to overcome poor access or unfavorable cricoid anatomy during PCMAF procedures. It is performed via a laryngofissure and consists of a posterior cricoid split with cartilage grafting, remobilization of the cricoarytenoid joints, and advancement of a vascularized PCMAF to achieve primary posterior glottic wound closure.…”

Section: Discussionmentioning

confidence: 99%

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

Filauro

Missale

Vallin

et al. 2022

Eur Arch Otorhinolaryngol

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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.

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Section: Discussionmentioning

confidence: 99%

“…The vast majority of these surgical procedures can be performed transorally, while an open-neck approach is reserved for more complex cases. Transoral CO 2 laser microsurgery (TOLMS) is strongly recommended for PGS Grades I–II [ 3 , 15 ]. Especially for PGS grade II, TOLMS is a valuable option in combination with PMAF [ 1 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

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

Filauro

Missale

Vallin

et al. 2022

Eur Arch Otorhinolaryngol

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“…The resected scar tissue is grafted with a mucosal advancement flap or a skin, perichondrocutaneous, or buccal mucosa graft. 30,[50][51][52][53][54] The posterior cricoid may be split with or without a costal cartilage graft placement. 30,51,54 A stent is often used for 2-8 weeks postoperatively.…”

Section: Adjuncts To Surgical Techniquementioning

confidence: 99%

“…30,[50][51][52][53][54] The posterior cricoid may be split with or without a costal cartilage graft placement. 30,51,54 A stent is often used for 2-8 weeks postoperatively. [50][51][52][53] Decannulation success arytenoidectomy.…”

Section: Adjuncts To Surgical Techniquementioning

confidence: 99%

“…24,25 In addition to restenosis and/or need for additional procedures, flap necrosis or displacement is uncommon but may occur. 53,54 Infection can also occur but does not appear to impact outcomes. 53 Subcutaneous emphysema is a risk in open procedures and was seen in the minicricothyrotomy approach by Mau et al; placement of a drain can assist in avoiding this complication.…”

Section: Complicationsmentioning

confidence: 99%

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Posterior Glottic Stenosis: A Review of Surgical Management Outcomes

Lackey¹,

Chabuz²,

Fink³

2022

International Journal of Head and Neck Surgery

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The objective of this review is to describe management options and their success in adults with acquired posterior glottic stenosis (PGS). Literature from PubMed search engine was reviewed, including recent and historical reports covering etiology, surgical techniques, and voice and swallowing outcomes in PGS. Damage to the posterior commissure after intubation is still the most common etiology for acquired PGS, with patients presenting with dyspnea weeks to months after injury. There is a multitude of surgical techniques described, regardless of the technique chosen, PGS is a challenging disease that often requires more than one procedure. Tracheostomy should be considered to secure the airway in the perioperative period, and decannulation is typically successful. Swallowing dysfunction is often temporary, and voice is often stable or improved after surgical intervention. As the laryngologist will continue to face this disease, especially with the recent pandemic, being familiar with various techniques options will be important in providing a safe and functional larynx.

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Posterior glottic stenosis: management and outcomes

DeHart

Richter

2020

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review Pediatric posterior glottic stenosis (PGS) is a challenging clinical entity with multiple treatment options. This review describes the evaluation of patients with PGS and discusses existing surgical techniques. Recent findings PGS secondary to a distinct scar band between the vocal folds can often be effectively managed with endoscopic division and surveillance. More advanced glottic scarring that also involves the interarytenoid mucosa, cricoarytenoid joints, or subglottis merits a more thorough investigation and repair. A postcricoid mucosal advancement flap can be employed in select adolescent or adult PGS, but long-term cricoarytenoid joint mobility is difficult to restore once it has been fixed. Younger pediatric patients have smaller airways and frequent concurrent subglottic stenosis which is better addressed with cartilage grafting. Summary Surgical success in pediatric PGS depends on careful preoperative airway assessment and the accurate characterization of airway stenosis. A surgical technique should be chosen based on the severity and extent of stenosis.

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Management of posterior glottic stenosis using the Combined Glottic Reconstruction procedure

Cited by 3 publications

References 3 publications

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

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

Posterior Glottic Stenosis: A Review of Surgical Management Outcomes

Posterior glottic stenosis: management and outcomes

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