Resolution of laryngeal injury following translaryngeal intubation

Translaryngeal intubation (TLI) causes mucosal ulcerations of the vocal cords and posterior laryngeal commissure. Usually these ulcers heal by primary reepithelialization, but occasionally laryngeal granulomas or strictures develop at these ulcer sites. The incidence of granuloma and stricture formation and the variables influencing abnormal laryngeal healing following TLI are not well understood. A group of 54 patients who experienced prolonged TLI were followed prospectively to determine the resolution rate of laryngeal injury. Direct fiberoptic laryngoscopy was performed at either extubation or tracheostomy and repeated every 2 wk until the larynx returned to normal or a persistent laryngeal abnormality was identified. Laryngeal symptoms were assessed at these same time points. In 5 patients (9%) the appearance of the larynx was normal at extubation, and in 42 patients (78%) laryngeal healing occurred by primary reepithelialization within 8 wk. Four patients (7%) developed laryngeal granulomas, which required surgical removal in all but one case. No patients in this series developed laryngeal strictures. Three patients (6%) died before complete follow-up. Laryngeal symptoms, particularly hoarseness, resolved as the larynx healed. Performance of tracheostomy, age, TLI for more than 10 days, and severe laryngeal injury at extubation did not influence the median time to resolution of laryngeal abnormalities. Abnormal laryngeal healing following TLI is uncommon but is not exacerbated by prolonged TLI (more than 10 days), severe laryngeal injury at extubation, or performance of a tracheostomy.