Surgical Treatment Modalities for Iatrogenic Anterior Glottic Stenosis

Abstract

The aim of this study was to describe common iatrogenic causes of anterior glottic stenosis and to investigate the surgical treatment outcomes of 3 different techniques aimed at repairing stenoses and preventing web reformation. Methods: Clinical information regarding patient demographics, presentation, etiology, treatment, and follow-up outcomes was obtained retrospectively through a review of patients' records between April 2010 and April 2017. Voice quality was evaluated using grade, roughness, breathiness, asthenia, and strain scale and Voice Handicap Index scores. Objective acoustic parameters were collected using the Kay Elemetrics Multi-Speech program. Results: Twenty patients were included in the study. Causes of glottic web formation included chemoradiation therapy and previous laryngeal surgery for polyps or malignant tumors at the anterior commissure. Web lysis with a CO 2 laser, intralaryngeal suturing, and keel placement were used in surgical treatment. Satisfactory results were achieved in 19 patients, and 1 recurrence was observed. Grade, roughness, breathiness, asthenia, and strain scale and Voice Handicap Index scores and objective voice variables for patients with Cohen type I or II webs improved significantly after the surgery. Conclusions: Treatment modalities for anterior glottic stenosis should be carefully chosen according to the etiology of the web, as well as the length and depth of the glottis involved.

Surgical management of acquired anterior glottic web: a systematic review

“…Of these, 13 studies met the inclusion criteria. 9– 21 Figure 1 shows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart.

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“…Four studies described the use of a mucosal flap to reduce the recurrence of anterior glottic web after division, in a total of 64 patients. 13,15,19,21 In these studies, the mucosal flap was used instead of a keel, to ensure that no two raw surfaces were left opposing each other. Deganello et al .…”

“…The study by Cao and Sun was the only one describing a technique that combined the use of both the mucosal flap technique and a 0.3 mm thick silicone keel for larger webs (9 out of 20 patients). 21 For patients with smaller webs, a mucosal flap technique using size 7-0 polypropylene sutures was applied to close at least one side of the freshly incised mucosa. The adhesive web tissues were removed with a CO 2 laser.…”

“…Eight studies with a combined total of 124 patients described the use of a keel following division of the anterior glottic web. 9,11–13,17,18,20,21 In all studies, silicone elastomer was used to fashion the keel, securing it with transcutaneous sutures tied over a button or silicone tube on the skin of the anterior neck. The interval between placing and removing the keel varied from two to five weeks.…”

“…The interval between placing and removing the keel varied from two to five weeks. In six of the eight studies, a second general anaesthetic was required, 9,12,13,17,18,21 with only two studies reporting opting to remove the keel transnasally or transorally in the consulting room. 11,20…”