gms | German Medical Science

Introduction: In severe cases of posterior glottic stenosis, when both cricoarytenoid joints (CAI) are destroyed and fixed by scar tissue, often only the external surgical interventions have been proven to be successful. These procedures require tracheostomy. The aim of this study is to introduce a minimally invasive endoscopic method.

Material & Methods: The results of 13 patients with a minimum of one year follow-up period (mean age:.43 years, SD ± 18 years) were examined. In 9 cases the structure of the CAI intraoperatively proved to be intact at least on one side. (A), with in the other 9 patients (B) both CAI structures were involved by the scar. In group A, the arytenoid cartilages were fixed temporarily in the physiological abducted position by one, endoscopically inserted suture (Prolene 1-0) for 6 weeks after the transsection of the posterior glottic scar by CO2 laser. In group B, the scar resections were extended with intracapsular scar transsection by a special blade, designed for this intervention by the authors. After this arytenoid cartilages were fixed definitively by the way mentioned above. Pre – (1), early postoperative (II) and late postoperative (III) (12th month) peak inspiratory flow (PIF) values were meastured.

Results: A: avg. PIF I:0,84 L/s, avg.PIF II:2,15 L/s, avg.PIF III: 2 L/s. The recovery of vocal cord function was supported by objevtive voice analysis in A, and the voice remained hoarse but socially acceptable in B.

Discussion: this minimally invasive method provides immediate and stable significant increase in breathing even int he difficult cases of posterior glotticstenosis without tracheotomy. Moreover, it can be a reversible method from the phonation’s point of view.