Asymptomatic Subglottic Stenosis Mimicking Double Vocal Folds After Temporary Tracheotomy

Significance Statement

Subglottic stenosis (SGS) often presents with significant respiratory symptoms that can deteriorate the quality of life. However, asymptomatic presentations provide a unique opportunity to explore the nuances of surveillance and management without the immediate pressures of symptom relief. This report describes a case of a 54-year-old male with postoperative asymptomatic SGS, discovered incidentally through routine laryngoscopy, mimicking double vocal folds, highlighting the role of vigilant surveillance and conservative management.

Case Report

A 54-year-old male, following a wide excision for squamous cell carcinoma of the left tongue, neck dissection, submental flap reconstruction, and temporary tracheotomy, developed asymptomatic subglottic stenosis (SGS) 6 months post surgery. An unusual presentation, mimicking double vocal folds, was discovered during a routine laryngoscopic examination, as depicted in Figure 1. A chest radiograph revealed a subtle abnormality in the subglottic area, shown in Figure 2. Despite the potential for moderate to severe symptoms of stenosis, such as respiratory or swallowing difficulties, wheezing, expectoration, hemoptysis, or hoarseness, the patient experienced none and declined further diagnostic procedures like bronchoscopy. Over 3 years of endoscopic monitoring confirmed the lesion’s stability without symptoms, highlighting the value of diligent surveillance in postsurgical patients with head and neck cancer and illustrating the efficacy of conservative management in such complex cases.

Figure 1.

Laryngoscopic view showing subglottic stenosis with proliferative tissue formations resembling a double set of vocal folds, incidentally identified during a postoperative examination. The circle (◎) marks the true vocal folds’ location, and the yellow asterisk (*) indicates the area of stenosis.

Figure 2.

Chest radiograph of the patient highlighting a subtle abnormality in the subglottic region indicated by an arrow (←), without accompanying symptoms typically associated with stenosis.

The etiological diversity of SGS, ranging from mechanical trauma to inflammatory conditions, underscores the necessity for a comprehensive diagnostic and therapeutic strategy. ¹ The case involves a 54-year-old male with postoperative asymptomatic SGS, exhibiting an uncommon presentation of proliferative tissue resembling double vocal folds. This emphasizes the critical role of advanced diagnostic modalities and conservative management.

Diagnostic efforts for SGS primarily rely on computed tomography scans for detailed anatomical visualization, which aids in assessing the extent and severity of the stenosis. ² The role of pulmonary function tests, particularly flow volume loop tracings, is invaluable in functional assessment, offering insights into airway obstruction dynamics. ³ Moreover, techniques such as bronchoscopy play a pivotal role not only in confirming the presence and characterizing the stenosis but also in evaluating its underlying etiology. ⁴ These comprehensive diagnostic measures are essential for a tailored therapeutic approach, especially in cases with unique presentations.

The management of SGS, as demonstrated in the discussed case, varies based on the severity and symptomatology of the stenosis. In asymptomatic individuals or those with mild stenosis, conservative management, including vigilant surveillance and periodic endoscopic monitoring, can be effective. This approach ensures the early identification of potential progression, allowing for timely intervention while avoiding unnecessary procedures. In more severe cases, a range of interventions, including bronchoscopic techniques and surgical reconstruction, might be considered to restore airway patency and function. ⁵ Therefore, the decision-making process in managing SGS must be dynamic, accommodating both the patient’s clinical condition and the characteristics of the stenosis.

This case underscores the importance of regular follow-ups in the postoperative management of head and neck cancer patients, particularly for detecting and monitoring conditions like SGS. Such diligent surveillance is pivotal in identifying asymptomatic stenoses, enabling the adoption of a conservative yet effective management strategy that mitigates the risks of progression while sparing patients from the potential complications of invasive procedures.