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Reconstructive transoral laser microsurgery for posterior glottic web with stenosis
Ihab Atallah1,2, M Krishniah Manjunath1,3, Ahmad Al Omari1,4
1Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
The Laryngoscope
|August 25, 2016
Summary
Reconstructive transoral laser microsurgery using a postcricoid mucosal advancement flap effectively treats posterior glottic web stenosis. This minimally invasive technique offers a safe alternative to open surgery, improving patient breathing.
Area of Science:
- Otolaryngology
- Head and Neck Surgery
- Laser Surgery
Background:
- Posterior glottic web-based stenosis (PGWS) can cause significant respiratory compromise.
- Traditional open surgical approaches for airway reconstruction carry inherent risks and morbidity.
Purpose of the Study:
- To evaluate the efficacy and safety of reconstructive transoral laser microsurgery (R-TLM) using a postcricoid mucosal advancement flap (PCMAF) for symptomatic PGWS.
- To demonstrate R-TLM as a viable alternative to open surgical reconstruction.
Main Methods:
- A retrospective cohort review of 52 patients with PGWS treated with R-TLM and PCMAF.
- The technique involved laser excision of scar tissue, mobilization of cricoarytenoid joints, and advancement of a PCMAF using microinstruments and a CO2 laser.
Main Results:
- All 52 patients were treated solely with R-TLM, with no open reconstructions or airway stents used.
- Successful decannulation was achieved in all patients who previously had a tracheostomy.
- Patients without a tracheostomy showed significant improvement in respiratory symptoms (mean Dyspnea Index change = 14.75, P < .01).
Conclusions:
- R-TLM with PCMAF is a feasible, safe, and effective endoscopic treatment for PGWS.
- This novel transoral technique offers a simpler, reproducible alternative to open airway reconstruction.
- The technique is suitable for laryngologists experienced in laryngeal microsurgery.
