Posterior Glottic Stenosis: Is Remobilization Possible?

Abstract

Objective: Surgical management of posterior glottic stenosis (PGS) should ideally result in vocal cord remobilization, rather than airway expansion via destructive glottic procedures. This study (1) presents surgical management of 10 cases of PGS, and (2) discusses a treatment algorithm for PGS which focuses on vocal cord remobilization.

Method: Ten cases of PGS with bilateral vocal fold immobility were retrospectively reviewed. Tracheotomy was initially performed to provide an adequate airway. Further interventions instituted focused on vocal cord remobilization. The main outcomes considered included decannulation, number and type of procedures performed, vocal cord mobility, voice quality, and exercise tolerance.

Results: Ten cases were reviewed. One patient was successfully decannulated without surgical intervention. Of the 9 patients requiring surgical intervention, 4 patients required a single procedure to be decannulated, and 4 patients required multiple interventions to be decannulated. The one patient not decannulated had an adequate glottic airway with limited arytenoid mobility, however, was not decannulated due to pending renal transplant. Six patients underwent midline thyrotomy with resection of posterior glottic scar and arytenoid remobilization. In all 6 of these patients some degree of vocal fold mobility was reestablished. Voice quality and exercise tolerance was adequate to excellent in all patients.

Conclusion: Patients with PGS can be decannulated through surgical intervention; however, following a treatment algorithm focusing on vocal cord remobilization may establish vocal fold mobility, and thus improve voice and airway dynamics.