The glottis is not round: Teardrop-shaped glottic dilation for early posterior glottic stenosis

Clark A. Rosen, Hailun Wang, Daniel Cates, Libby J. Smith

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Objectives: Posterior glottic stenosis (PGS) results in severe derangement of laryngeal configuration and function with significant morbidity as a sequalae. Presently, there is no treatment for patients with “early” PGS. Dilation is often used for stenotic disease, but present dilation methods are limited to a round shape and the glottis is a sector (teardrop-shaped). Round dilation of the larynx results in compression of the membranous vocal folds (with potential for injury) and minimal expansion of the posterior larynx. We present a novel laryngeal dilation method that matches the unique anatomic shape of the glottis: teardrop-shaped glottis dilation (TSGD). Methods: We present a clinical series of early PGS patients treated with a TSGD. Five patients with dyspnea and significantly reduced vocal fold mobility due to early PGS were treated with TSGD, which involves placement of a triangular static stent in the anterior glottis, with simultaneous use of a round balloon dilator in the posterior glottis. Results: All patients reported improved ease of breathing and decrease in Dyspnea Index score and were decannualated following treatment. Video perceptual analysis of pre-/postlaryngoscopy examinations was performed with five blinded reviewers, and all patients were scored to have improved posterior glottic airway space following treatment with a mean improvement of 2.4 on a 11-point scale. Conclusion: These clinical results demonstrate that there is enormous potential for the identification and treatment of patients with early PGS and use of a laryngeal dilation technique that matches the anatomic configuration of the glottis. Level of Evidence: 4. Laryngoscope, 2018.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

Keywords

  • balloon dilation
  • bilateral vocal fold immobility
  • dyspnea
  • laryngeal dilation
  • laryngeal stenosis
  • PGS
  • Posterior glottic stenosis

ASJC Scopus subject areas

  • Otorhinolaryngology

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