Posterior Glottic Stenosis Type I: Clinical Presentation and Postoperative Course

Abstract

Posterior glottic stenosis (PGS) is a process that results in partial or total fixation of the vocal folds. Type I PGS (PGS-1) is an uncommon clinical entity that results from an interarytenoid adhesion/scar band that is separate from the posterior interarytenoid mucosa. We present a case series of patients with PGS-1 treated at our institution to contribute to the understanding of this complex clinical entity.

Type I posterior glottic stenosis: an endoscopic approach

“…PGS can result in glottic flow compromise with limited vocal fold abduction. 3 PGS type I is the rarest type and is frequently caused by intubation injury to interarytnoide tissue that causes pressure necrosis, mucosal breakdown, formation of granulation tissue, and subsequent scarring. 1,7 Laryngotracheal trauma during intubation should be minimized in pediatric patients.…”

“…2 PGS is a group of laryngotracheal stenosis which is defined by the presence of fibrotic process to the interarytenoid glottis that results in partial or total fixation of the vocal folds. 3,4 In addition to prolonged endotracheal intubation otlher mechanisms may be responsible for the appearance of PGS such as: radiation exposure, systemic autoimmune disease, external trauma and caustic ingestion. 4 PSG is classified based on the classification made by Bogdasarian and Olson in 4 types.…”

“…5 In type I PSG there is an interarytenoid synechia/adhesion that is separate from the posterior interarytenoid mucosa. 3,6 Type II envolves stenosis of the posterior commissure. Type III is posterior commissure stenosis with unilateral cricoarytenoid ankylosis, and type IV is posterior commissure stenosis with cricoarytenoid bilateral ankylosis.…”

Functional outcomes after transoral CO2 laser treatment for posterior glottic stenosis: a bicentric case series

“…The most common etiology of PGS is prolonged and/or traumatic intubation. Indeed, a direct correlation between duration of orotracheal intubation and the incidence of PGS has been reported, occurring in 5% of patients intubated for 5–10 days and in 12% of patients intubated for 11–24 days [ 3 ]. The traumatic pressure of the endotracheal tube on the posterior commissure is the most common cause of mucosal ulceration, chondritis, prolonged inflammation with exuberant granulation tissue formation, and consequential fibrosis that extends to the arytenoid and, finally, to the cricoarytenoid joint [ 2 ].…”

“…The vast majority of these surgical procedures can be performed transorally, while an open-neck approach is reserved for more complex cases. Transoral CO 2 laser microsurgery (TOLMS) is strongly recommended for PGS Grades I–II [ 3 , 15 ]. Especially for PGS grade II, TOLMS is a valuable option in combination with PMAF [ 1 , 4 ].…”