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Published on: December 1, 2023
Posterior glottic diastasis: mechanically deceptive and often overlooked.
Steven M Zeitels1, Alessandro de Alarcon, James A Burns
1Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.
The Annals of Otology, Rhinology, and Laryngology
|March 12, 2011
Summary
This study addresses dysphonia caused by posterior glottic incompetence, often resulting from intubation injuries. Surgical reconstructions show promise in restoring voice function by correcting this specific phonatory impairment.
Area of Science:
- Laryngology
- Voice Science
- Surgical Innovation
Background:
- Dysphonia can stem from posterior glottic aerodynamic incompetence, a challenge in visual diagnosis.
- This impairment arises from injuries during airway instrumentation, specifically affecting posterior glottic closure.
- Existing diagnostic challenges include obscured views and a lack of standardized nomenclature for cricoarytenoid region injuries.
Observation:
- A retrospective review of 3 patients with posterior phonatory incompetence post-laryngotracheal intubation was conducted.
- All patients had cricoarytenoid joint injuries; two had prior unsuccessful medialization laryngoplasty.
- Surgical interventions were designed to address persistent posterior glottic insufficiency.
Findings:
- Novel surgical techniques were developed and performed, including laryngofissure with cricoid resection, flap advancement, and submucosal augmentation.
- These procedures aimed to correct the mechanical impairment in posterior glottic closure.
- The term "glottic diastasis" is proposed to describe the inability to adduct arytenoid cartilages.
Implications:
- The study introduces new surgical approaches for a difficult-to-treat voice disorder.
- Successful reconstruction offers hope for patients suffering from post-intubation voice impairment.
- Further research and experience are needed, but initial results for surgical reconstruction are encouraging.
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