Laser bronchoscopy with transglottic/supraglottic ventilation to relieve dysphonia and subglottic obstruction

Dysphonia after endotracheal intubation usually indicates a glottic lesion but it can also herald an obstructing subglottic airway mass. Outpatient strobovideolaryngoscopy may be anatomically extended by transglottic videotracheobronchoscopy to achieve a thorough examination of the proximal bronchi, trachea, subglottis, glottis, and supraglottis in selected cases. Combining these techniques with lateral soft tissue x-ray studies of the neck in two patients with dysphonia and stridor, nearly identical postendotracheal intubation subglottic severely obstructing granulation "tumors" were diagnosed. Operative subglottic resection with a rigid ventilating laser bronchoscope combined with transglottic/supraglottic anesthetic ventilation techniques and contact-tip Nd-YAG laser phototherapy relieved the dysphonia and airway obstruction simultaneously. Normal vocal quality and full anatomical airway patency were achieved in both cases. Follow-up postoperative vocal rehabilitation and medical therapy sustained the surgical results.