Postlaryngectomy supraglottic stenosis revealed by three-dimensional computed tomography reconstruction

Abstract

Rationale: Supraglottic stenosis is a rare cause of airway obstruction. It can be induced by radiation, trauma, autoimmune diseases, or caustic exposure, and is often misdiagnosed as asthma. Detailed airway information is necessary to re-establish the normal functioning of the airway.Patient concerns: A 78-year-old woman with severe dyspnea and hypercarbia was scheduled for surgery to resolve airway obstruction, previously known as supraglottic stenosis.Diagnoses: To determine the exact internal shape of the stenotic lesion, we reconstructed three dimensional computed tomography (CT) images depicted a tubular supraglottic stenosis. Interventions:The patient underwent tracheotomy under monitored anesthesia care and local anesthesia, followed by general anesthesia. For long-term management of the patient, the otorhinolaryngologist excised the supraglottic stricture via micro-laryngeal surgery using a CO 2 laser and applied mitomycin to prevent further obstruction.Outcomes: The patient recovered uneventfully after anesthesia, and symptom due to supraglottic stenosis was improved.Lessons: During airway management of patients with postlaryngectomy supraglottic stenosis, three-dimensional reconstructed computed tomography images facilitate airway configuration in addition to endoscopy and other radiological findings.Abbreviations: ABGA = arterial blood gas analysis, CT = computed tomography, HFNC = high-flow nasal cannula, MAC = monitored anesthesia care.