Glottic Stenosis: An Anatomic Analysis and New Treatment With a Self-Retaining Interarytenoid Spring. (March 2019)

• Record Type: Journal Article
• Authors: Zeitels, Steven M.; Lombardo, Patrick; Chaves, Jaime L.; Burns, James A.; Hillman, Robert E.; Heaton, James T.; Kobler, James B.
• Is Part Of: Annals of otology, rhinology & laryngology. Volume 128:Number 3(2019)Supplement
• Page Start: 94S
• Page End: 105S
• Publication Date: 2019-03
• Subjects: glottic stenosis -- endotracheal tube injury -- airway stenosis -- voice outcome -- vocal cord injury -- vocal fold injury; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0003489418802284
• Languages: English
• ISSNs: 0003-4894

Abstract

Introduction: Endotracheal (ET) intubation is a common cause of acquired glottic stenosis. Severe cases often require an irreversible arytenoidectomy/cordectomy, which typically results in poor voice quality. Adult human cadaver larynges were studied to gain insights about ET tube–induced posterior glottic injuries, hoping to create a less invasive remedy. Study Design: Human cadaver investigation and case reports. Methods: Microlaryngeal assessments were done on 10 human cadaver larynges (5 men, 5 women) with and without ET tubes. After supracricoid soft tissue resection, measurements were obtained, including the distance between the outer diameter of the ET tube and the medial aspect of the cricoarytenoid joint facet. Additionally, measurements of the circumferential arc of differently sized ET tubes were made alongside both cricoarytenoid joint capsules. This information was used to design a silastic stent that would function as a self-retaining interarytenoid spring to treat posterior glottic stenosis in 5 patients. Four of 5 patients included in the clinical study were tracheotomy dependent, primarily because of glottic stenosis. The human surgical technique is described in detail. Results: The shortest distance between the outer diameter of the ET tube to the medial cricoid facet averaged 5.02 mm in men and 3.62 mm in women. On the basis of the diameter of the intralaryngeal component of the initially round stent, and the position of the cricoarytenoid joint facets, the interarytenoid spring would have a subtended arc between 110° and 175°. These data helped fashion parameters for modifying a conventional T-tube to form a new self-retaining silastic interarytenoid spring. The first 5 human cases have been successful, allowing effective tracheotomy tube decannulation and excellent voice quality. Conclusions: The anatomic investigation herein provided key insights into ET tube–induced glottic stenosis and facilitated a new straightforward procedure to surgically improve the airway yet preserve excellent vocal function in patients with acquired glottic stenosis. Level of Evidence: NA