Endoscopic Posterior Rotation Flap for Posterior Glottic Insufficiency

Kobayashi, Kenji; You, Peng; Devore, Danielle; Hollas, Sarah; Geraghty, Joseph R; Ongkasuwan, Julina

doi:10.1002/lary.30026

Cited by 1 publication

(8 citation statements)

References 6 publications

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“…This effectively decreases interarytenoid distance, thus increasing subglottic pressure generation and thereby improving vocal projection. 8,10 In our review, most PCR patients had substantial improvements in vocal quality both subjectively assessment and by patient reported outcomes measures (Table I). Although its success is notable, improvements in vocal quality must be weighed against the threat of potential airway compromise due to a decreased airway aperture.…”

Section: Surgical Techniques and Outcomesmentioning

confidence: 85%

“…1): 51 were excluded as duplicates, and 38 were reviewed for inclusion. Twenty‐nine were eliminated based on inclusion criteria and nine 1,3,8–14 remained for full review (Table I). Most of the articles were from the United States (7/9), one from Ireland, and one from Chile.…”

Section: Resultsmentioning

confidence: 99%

“…Both free and local tissue flaps were utilized in the selected studies. 3,9,10,14 In the one case of free mucosal grafting, buccal tissue was grafted onto a resurfaced interarytenoid region via open transcervical approach. 9 Although the technique is associated with more initial surgical morbidity, the patient reported had favorable a voice outcome and the graft appeared healthy 1-2 years post-surgery.…”

Section: Surgical Techniques and Outcomesmentioning

confidence: 99%

“…Graft donor locations reported were pharyngoepiglottic, aryepiglottic, and arytenoid mucosa. 3,10,14 In this technique, endoscopic grafts are lifted, repositioned, and sutured into the posterior mucosal defect. They essentially act as a plug to fill the keyhole defect and preventing air escape.…”

Section: Surgical Techniques and Outcomesmentioning

confidence: 99%

“…Vocal outcomes were by-and-large favorable, though some patients had a persistent raspy voice likely from the discontinuity caused by grafted mucosa along the free margin of the VF. 10,14 Like the free buccal graft, local flaps allow for targeted correction of medial arytenoid mucosa deficiency and vocal process troughs/divots without substantially increasing the risk of airway compromise. Similar techniques have been used to correct posterior glottic stenosis (PGS).…”

Section: Surgical Techniques and Outcomesmentioning

confidence: 99%

See 4 more Smart Citations

Scoping Review of Surgical Rehabilitation of Post Intubation Phonatory Insufficiency

Ferraro,

Blunck,

Benninger

et al. 2023

The Laryngoscope

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ObjectivesPost intubation phonatory insufficiency (PIPI) or posterior glottic diastasis describes posterior glottic insufficiency (PGI) caused by prolonged intubation causing medial arytenoid ulceration, mucosal scarring, and incomplete cricoarytenoid joint adduction. The purpose of this review is to showcase diagnostic findings, surgical rehabilitation, and gaps in our treatment algorithm of PIPI.Data SourcesEmbase, PubMed, Scopus, Web of Science.Review MethodsTwo independent reviewers completed a systematic search of the literature studying PIPI. Reported intubation history, laryngeal defect, clinical symptoms, surgical intervention, and outcomes were gathered from included studies.ResultsNine studies met our inclusion criteria for full review, (45 patients) all of which were case reports/series. All patients had posterior glottic defects, most commonly loss of medial arytenoid tissue, causing varying degrees of PGI. Eleven patients had vocal fold (VF) immobility or hypomobility. Treatment interventions were observation (1), speech therapy (2), VF or posterior glottic injection augmentation (15), medialization laryngoplasty (4), arytenoid repositioning (6), endoscopic (19) or open (3) posterior cricoid reduction, local mucosal rotation flap (11), or free mucosal graft (2) to fill the glottic defect. Observation, voice therapy, and augmentation or type 1 laryngoplasty failed to improve symptoms. Other surgical techniques improved symptoms with varying outcomes.ConclusionPIPI is a difficult injury to diagnosis and treat. Conservative measures and augmentation/laryngoplasty often fail to fix the PGI. Our review supports symptom improvement with reconstruction of the posterior glottic defect with cricoid reduction or mucosal grafts. Future investigation is needed to better define the diagnosis and successful treatment algorithm. Laryngoscope, 2023

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Section: Surgical Techniques and Outcomesmentioning

confidence: 85%

Section: Resultsmentioning

confidence: 99%