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Endoscopic treatment of glottic stenosis: a report on the safety and efficacy of CO2 laser

Published online by Cambridge University Press:  01 November 2011

F Riffat ,
C E Palme  and
D Veivers
F Riffat*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Royal North Shore Hospital and Westmead Hospital, Sydney, New South Wales, Australia
C E Palme
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Royal North Shore Hospital and Westmead Hospital, Sydney, New South Wales, Australia
D Veivers
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Royal North Shore Hospital and Westmead Hospital, Sydney, New South Wales, Australia
*
Address for correspondence: Dr F Riffat, Suite 6/66 North Shore Medical Centre, Pacific Highway, St Leonards, Sydney, New South Wales 2065, Australia E-mail: [email protected]
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Abstract

Background:

Treatment of glottic stenosis is a considerable challenge to the otolaryngologist. Glottic airway patency can be compromised by bilateral vocal fold palsy, anterior webbing or a posterior segment scar, which may be significant enough to impair arytenoid movement.

Method:

A retrospective analysis of a prospective database of patients (n = 34) treated by a specialist airway surgeon. All patients underwent endoscopic treatment with a CO2 laser in an attempt to improve airway calibre and, in 12 patients, to decannulate tracheostomy tubes.

Results:

Twenty-one patients had bilateral vocal fold palsy and 13 had predominantly posterior glottic stenosis. A variety of pathology-directed treatment approaches were used to achieve good functional results. Four patients required a second endoscopic procedure. The overall revision rate was 5 per cent for bilateral fold palsy and 23 per cent for posterior glottic stenosis (p < 0.05). All patients had an adequate functional airway calibre, and all 12 tracheotomised patients were decannulated.

Discussion:

Pathology-directed endoscopic laser surgery is safe and effective treatment for glottic stenosis. Rather prescriptive use of unilateral or bilateral cordotomy or combined cordo-arytenoidectomy, clinicians must perform the procedure that will treat the lesion most adequately. Our success rate compared favourably with the best reported results.

Keywords

Vocal Cord ParalysisCordotomyArytenoidectomyLasers, CO2
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 5 , May 2012 , pp. 503 - 505
Copyright
Copyright © JLO (1984) Limited 2011

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