Postintubation Interarytenoid Adhesion

Abstract

Interarytenoid fibrous adhesion is a poorly recognized complication of intubation and is frequently confused with bilateral vocal cord paralysis. Early diagnosis and treatment is essential for optimal management. Otolaryngologists should constantly remain alert for interarytenoid fibrous scar to establish the diagnosis as early as possible, optimizing the probability of restoring normal breathing and quality of life and avoiding an unnecessary tracheotomy. Surgical laser reduction is appropriate in all cases when other miscellaneous laryngeal injury lesions are eliminated. Direct laryngoscopy with careful examination of the posterior commissure and laryngeal electromyography are the 2 main clinical diagnostic aids contributing to establish the diagnosis.

Complications of Airway ManagementDiscussion

“…Failure to adequately abduct with inspiration can compromise the airway and lead to dyspnea, stridor, or respiratory failure. 81 As the scar matures in the weeks after extubation, the posterior glottis becomes progressively narrower, resulting in the development of exertional dyspnea with inspiratory stridor. If an office laryngeal examination confirms that vocal cord abduction is reduced or absent, further laryngeal examination of the patient under anes- thesia may be warranted to examine the posterior glottis.…”

Glottic scar bands following intubation

“…Most sequelae involve the area of the tube–tissue interface in the posterior aspect of the larynx (1).…”

“…Granuloma formation occurs. If this occurs bilaterally and the granulomas meet in the midline fusion occurs creating a fibrous bridge of tissue or glottic scar band as in these cases (1). This may mimic the signs and symptoms of bilateral vocal cord palsy – often presenting with voice changes and shortness of breath on exertion.…”

“…Ninety-four percent of patients intubated long term suffered from laryngeal damage. In fact even short-term intubation results in vocal cord immobility in 6-30% of patients (1).…”

5 Laser in Larynx, Hypopharynx und Trachea bei gutartigen Erkrankungen

“…Die Unterscheidung zwischen Lähmung und Ankylose ist deshalb wichtig, weil bei einer Ankylose häufig eine Arytaenoidektomie zur Glottiserweiterung unverzichtbar ist, und diese gelegentlich auch am tracheotomierten Patienten erfolgen muss, während glottiserweiternde Maûnahmen bei beidseitiger Rekurrenslähmung in der Regel ohne vorhergehende Tracheotomie am intubierten Patienten durchgeführt werden können [89,113,114].…”