Subglottic Mucosal Flap: Endoscopic Single‐Stage Reconstruction for Anterior Glottic Stenosis

Lahav, Yonatan; Warman, Meir; Halperin, Doron; Cohen, Oded; Shapira‐Galitz, Yael; Shoffel‐Havakuk, Hagit

doi:10.1002/lary.29799

Cited by 5 publications

(2 citation statements)

References 33 publications

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“…The following glottic measurements were performed on selected images from video‐laryngoscopic examinations: (1) Maximal glottic opening angle (MGOA) 22 as depicted in Figure 1A. MGOA was measured at maximal abduction as the angle between the free edges of VFs at the anterior commissure.…”

Section: Methodsmentioning

confidence: 99%

Dilation, Steroid Injection, and Cough Exercise for Correction of Posterior Glottic Stenosis

et al. 2022

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Objective To describe the DISCO protocol (Dilation, Steroid injection, and post‐operative Cough Exercise); a novel treatment for posterior glottic stenosis (PGS). Restoring glottic mobility in PGS is a major challenge. In orthopedic and plastic surgery, post‐operative physical therapy is associated with improved motion range and flexibility; yet, this principle was never applied to laryngeal surgery. Methods A retrospective cohort of PGS adult patients, treated by the DISCO protocol during 2018–2020. DISCO involves the following: scar release, glottic dilation, and steroid injection, followed by post‐operative cough as glottic physical therapy. Maximal glottic opening angle (MGOA), relative glottic opening area (RGOA), and relative glottic insufficiency area (RGIA) were calculated before and post‐operatively. Results Seventeen patients were included; PGS etiology was post‐intubation (n = 10), post‐irradiation (n = 3), both (n = 1) and joint sclerosis (n = 3). Six patients also had additional airway disorders. Sixteen patients were tracheostomy‐dependent. 2 (12%), 8 (47%) and 7 (41%) patients had type II, III and IV stenosis, respectively. Surgery included scar release, dilation and steroid injection alone in 7 patients; and additional unilateral sub‐mucosal arytenoidectomy in 10. The mean follow‐up was 17.5 months. There were no major complications. Successful outcomes (e.g., decannulation or permanent capping) were achieved in 14 (82%) patients with some restoration of joint movement. None had a persistent voice or swallowing complaints. Both MGOA and RGOA increased in all patients (p < 0.001). RGIA remained unchanged (p = 0.878). Conclusions The DISCO protocol is a novel, effective and safe approach for PGS correction that can be easily applied. It can restore vocal fold mobility and may expand the glottic airway without causing glottic insufficiency. Level of Evidence 4 Laryngoscope, 133:883–889, 2023

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Section: Methodsmentioning

confidence: 99%

Dilation, Steroid Injection, and Cough Exercise for Correction of Posterior Glottic Stenosis

et al. 2022

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“…The angle created by lines from the vocal process to anterior commissure were observed in each image was measured using ImageJ software as the angle produced where the median edges of the vocal cords meet to form the anterior commissure during maximum glottic abduction. 10 (Fig. 1) All maximum glottic abduction images were obtained and measured by the same individual.…”

Section: Image Analysismentioning

confidence: 99%

Clinical and Anatomical Variation During Assessment of Maximum Glottic Angle

DeChance,

Frank,

Dehom

et al. 2024

The Laryngoscope

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IntroductionQuantitative measurement and analysis of glottic abduction is used to assess laryngeal function and success of interventions; however, the consistency of measurement over time has not been established. This study assesses the consistency of glottic abduction measurements across visits in healthy patients and anatomic factors impacting these measurements.MethodsReview of patients with two sequential flexible stroboscopic exams over seven months from 2019–2022. Images of maximal glottic abduction were captured and uploaded into and measured with ImageJ. Cadaver heads were used to assess the impact of visualization angles on glottic measurements with a monofilament inserted into the supraglottis of each cadaver as a point of reference. Comparisons were done with a paired T‐test, T‐test, or Mann–Whitney U test as appropriate.ResultsFifty‐nine patients and twenty‐six cadaveric exams were included. Absolute change in maximum glottic abduction angle (MGAA) was 6.90° (95% CI [5.36°, 8.42°]; p < 0.05). There were no significant differences in change in MGAA by gender or age. Twenty percent of patients had a change of at least 25% in their MGAA between visits. Absolute differences in glottic angle between nasal side for cadaveric measurements was 4.77 ± 4.59° (p < 0.005)—2.22° less than the change in MGAA seen over time (p = 0.185).ConclusionMaximal glottic abduction angles varied significantly between visits. Factors considered to be contributing to the differences include different viewing windows between examinations due to the position and angulation of the laryngoscope and changes in patient positioning, intra‐ and inter‐rater variations in measurement, and patient effort.Level of EvidenceN/a Laryngoscope, 2024

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Anterior glottic webs

Karle

Lott

2023

Operative Techniques in Otolaryngology-Head and Neck Surgery

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Subglottic Mucosal Flap: Endoscopic Single‐Stage Reconstruction for Anterior Glottic Stenosis

Cited by 5 publications

References 33 publications

Dilation, Steroid Injection, and Cough Exercise for Correction of Posterior Glottic Stenosis

Dilation, Steroid Injection, and Cough Exercise for Correction of Posterior Glottic Stenosis

Clinical and Anatomical Variation During Assessment of Maximum Glottic Angle

Anterior glottic webs

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