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Using the Glottic Angle and Area in Cases of Bilateral Vocal Fold Paralysis
Tzu-Ying Chen1, Hsing-Won Wang2,3,4
1Department of Otolaryngology-Head and Neck Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
Ear, Nose, & Throat Journal
|December 14, 2024
Summary
In cases of bilateral vocal fold paralysis, a glottic angle less than 12.2° or glottic area smaller than 25.2 mm² indicates a need for airway intervention. This helps determine safe and necessary procedures like intubation or tracheostomy.
Area of Science:
- Otolaryngology
- Laryngology
- Airway Management
Background:
- Bilateral vocal fold paralysis presents a significant challenge to maintaining a patent airway.
- Objective assessment of glottic dimensions is crucial for guiding clinical decisions.
Purpose of the Study:
- To establish objective criteria for safe and necessary airway interventions in patients with bilateral vocal fold paralysis.
- To determine the diagnostic value of glottic angle and area measurements.
Main Methods:
- Retrospective analysis of laryngoscopic photographs from 26 patients with bilateral vocal fold paralysis (January 2008 - December 2023).
- Measurement of glottic angles and calculation of glottic areas using average vocal fold length specific to gender.
- Independent measurements by two clinicians to ensure reliability.
Main Results:
- The average glottic angle was 10.3° ± 7.3°.
- Patients requiring intervention (N=17) had a significantly smaller average glottic angle (7.1° ± 3.7°) and area (14.2 ± 7.5 mm²).
- Patients not requiring intervention (N=9) had a larger average glottic angle (16.3° ± 8.9°) and area (27.2 ± 9.4 mm²).
Conclusions:
- A glottic angle <12.2° or glottic area <25.2 mm² suggests the need for emergent airway intervention.
- These quantitative measures provide valuable guidance for managing airway compromise in bilateral vocal fold paralysis.
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