Vocal cord mobilization by posterior laryngoplasty

Laryngeal obstruction due to fixation of the vocal cords by scar tissue in the posterior commissure is a serious complication of endotracheal intubation. Until recently, operative procedures, including unilateral arytenoidectomy, were recommended for the relief of such obstruction. Because arytenoidectomy adversely affects voice quality, alternative procedures designed to open the airway by restoring vocal cord mobility have been attempted with some success. We report our experience with six consecutive patients, five of whom had previously required tracheotomy for relief of airway obstruction from posterior glottic stenosis. In all patients, the operative procedure included a midline thyrotomy, excision of the posterior commissure scar tissue, and stenting. Vocal cord motion returned to normal or near normal in all six patients, and all have been decannulated. Subjective evaluation of voice quality was the same or improved postoperatively. Our experience suggests that restoration of an adequate airway in patients with posterior glottic stenosis can be achieved without sacrificing an arytenoid cartilage and voice quality.