Hostname: page-component-76fb5796d-vfjqv Total loading time: 0 Render date: 2024-04-27T19:08:16.688Z Has data issue: false hasContentIssue false
  • English
  • Français

Endoscopic treatment of glottic stenosis: a report on the safety and efficacy of CO2 laser

Published online by Cambridge University Press:  01 November 2011

F Riffat ,
C E Palme  and
D Veivers
F Riffat*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Royal North Shore Hospital and Westmead Hospital, Sydney, New South Wales, Australia
C E Palme
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Royal North Shore Hospital and Westmead Hospital, Sydney, New South Wales, Australia
D Veivers
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Royal North Shore Hospital and Westmead Hospital, Sydney, New South Wales, Australia
*
Address for correspondence: Dr F Riffat, Suite 6/66 North Shore Medical Centre, Pacific Highway, St Leonards, Sydney, New South Wales 2065, Australia E-mail: friffat@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Treatment of glottic stenosis is a considerable challenge to the otolaryngologist. Glottic airway patency can be compromised by bilateral vocal fold palsy, anterior webbing or a posterior segment scar, which may be significant enough to impair arytenoid movement.

Method:

A retrospective analysis of a prospective database of patients (n = 34) treated by a specialist airway surgeon. All patients underwent endoscopic treatment with a CO2 laser in an attempt to improve airway calibre and, in 12 patients, to decannulate tracheostomy tubes.

Results:

Twenty-one patients had bilateral vocal fold palsy and 13 had predominantly posterior glottic stenosis. A variety of pathology-directed treatment approaches were used to achieve good functional results. Four patients required a second endoscopic procedure. The overall revision rate was 5 per cent for bilateral fold palsy and 23 per cent for posterior glottic stenosis (p < 0.05). All patients had an adequate functional airway calibre, and all 12 tracheotomised patients were decannulated.

Discussion:

Pathology-directed endoscopic laser surgery is safe and effective treatment for glottic stenosis. Rather prescriptive use of unilateral or bilateral cordotomy or combined cordo-arytenoidectomy, clinicians must perform the procedure that will treat the lesion most adequately. Our success rate compared favourably with the best reported results.

Keywords

Vocal Cord ParalysisCordotomyArytenoidectomyLasers, CO2
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 5 , May 2012 , pp. 503 - 505
Copyright
Copyright © JLO (1984) Limited 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Laccourreye, O, Escovar, M, Gerhardt, J, Blacabe, B, Brasnu, D. CO2 laser endoscopic posterior partial cordotomy for bilateral paralysis of the vocal cord. Laryngoscope 1999;109:415–18CrossRefGoogle Scholar
2Eckel, HE, Thumfart, M, Wasserman, K. Cordectomy versus arytenoidectomy in the management of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol 1994;103:852–7CrossRefGoogle ScholarPubMed
3Segas, J, Stavroulakis, P, Manolopoulous, L. Management of bilateral vocal cord paralysis: experience at University of Athens. Otolaryngol Head Neck Surg 2001;124:68–71CrossRefGoogle ScholarPubMed
4Kashima, HK. Bilateral vocal fold motion impairment: pathophysiology and management by transverse cordotomy. Ann Otol Rhinol Laryngol 1991;100:717–21CrossRefGoogle ScholarPubMed
5Crumley, RL. Endoscopic laser medial arytenoidectomy for airway management in bilateral laryngeal paralysis. Ann Otol Rhinol Laryngol 1993;102:81–4CrossRefGoogle ScholarPubMed
6Remacle, M, Lawson, G, Mayne, A. Subtotal carbon dioxide laser arytenoidectomy by endoscopic approach for treatment of bilateral cord immobility in adduction. Ann Otol Rhinol Laryngol 1996;105:438–45CrossRefGoogle ScholarPubMed
7Wilson, JA, Webb, A, Carding, PN, Steen, IN, Mackenzie, K, Deary, IJ. The Voice Symptom Scale (VoiSS) and the Vocal Handicap Index (VHI): a comparison of structure and content. Clin Otolaryngol 2004;29:169–74CrossRefGoogle ScholarPubMed
8Bajaj, Y, Sethi, N, Shayah, A, Harris, AT, Henshaw, P, Coatesworth, AP et al. Vocal fold paralysis: role of bilateral transverse cordotomy. J Laryngol Otol 2009;122:1348–52CrossRefGoogle Scholar
9Spector, JE, Werkhaven, JA, Spector, NC. Prevention of anterior glottic restenosis in a canine model with topical mitomycin-C. Ann Otol Rhinol Laryngol 2001;110:1007–10CrossRefGoogle Scholar
10Spector, JE, Werkhaven, JA, Spector, NC. Preservation of function and histologic appearance in the injured glottis with topical mitomycin C. Laryngoscope 1999;109:1125–9CrossRefGoogle ScholarPubMed