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Laryngoscope. 2018 Dec 27. doi: 10.1002/lary.27594. [Epub ahead of print]

The glottis is not round: Teardrop-shaped glottic dilation for early posterior glottic stenosis.

Author information

1
Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.

Abstract

OBJECTIVES:

Posterior glottic stenosis (PGS) results in severe derangement of laryngeal configuration and function with significant morbidity as a sequalae. Presently, there is no treatment for patients with "early" PGS. Dilation is often used for stenotic disease, but present dilation methods are limited to a round shape and the glottis is a sector (teardrop-shaped). Round dilation of the larynx results in compression of the membranous vocal folds (with potential for injury) and minimal expansion of the posterior larynx. We present a novel laryngeal dilation method that matches the unique anatomic shape of the glottis: teardrop-shaped glottis dilation (TSGD).

METHODS:

We present a clinical series of early PGS patients treated with a TSGD. Five patients with dyspnea and significantly reduced vocal fold mobility due to early PGS were treated with TSGD, which involves placement of a triangular static stent in the anterior glottis, with simultaneous use of a round balloon dilator in the posterior glottis.

RESULTS:

All patients reported improved ease of breathing and decrease in Dyspnea Index score and were decannualated following treatment. Video perceptual analysis of pre-/postlaryngoscopy examinations was performed with five blinded reviewers, and all patients were scored to have improved posterior glottic airway space following treatment with a mean improvement of 2.4 on a 11-point scale.

CONCLUSION:

These clinical results demonstrate that there is enormous potential for the identification and treatment of patients with early PGS and use of a laryngeal dilation technique that matches the anatomic configuration of the glottis.

LEVEL OF EVIDENCE:

4. Laryngoscope, 2018.

KEYWORDS:

PGS; Posterior glottic stenosis; balloon dilation; bilateral vocal fold immobility; dyspnea; laryngeal dilation; laryngeal stenosis

PMID:
30588628
DOI:
10.1002/lary.27594

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