Laryngeal and tracheal stenosis have been refractory to a wide variety of treatments including dilation, stents, or have required major open operation, e.g., laryngofissure with and without skin or mucosal grafts and segmental resection with larynx release. Adequate airway even when achieved was frequently at the expense of voice quality and significant morbidity or mortality. A new highly successful endoscopic technique is described for the treatment of posterior glottic stenosis (apparent bilateral vocal cord paralysis), subglottic stenosis, and tracheal stenosis up to 1 cm thick. The procedure involves the endoscopic use of the CO2 laser, and a micro-trapdoor mucosal flap. Ninety percent of the patients in the group studied obtained an adequate airway with good voice quality and no tracheotomy was required in those patients not already having one. In 19 patients there was no mortality and essentially no morbidity.
Patients with acquired immune deficiency syndrome (AIDS) frequently present with signs and symptoms referable to the head and neck. Three hundred ninety-nine patients with AIDS presented at the University of California, San Francisco and its affiliated hospitals from 1980 to April 1984. One hundred sixty-five patients (41%) with AIDS presented with, or had on initial evaluation, head and neck manifestations. Of that group, 58 (35%) had cutaneous, oral, and pharyngeal lesions of Kaposi's sarcoma; 51 (31%) had oral, pharyngeal, esophageal, or laryngeal candidiasis; 36 (22%) had chronic cough and shortness of breath; 13 (8%) had rapidly enlarging neck masses; and 7 (4%) had herpes simplex lesions. With the increasing number of cases of AIDS it is important for the otolaryngologist to be aware of these presentations.
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