Monday, May 8, 2017

Return to: Laryngeal Surgery (Benign Disease) Protocols

Etiology

  • Acute swelling of the supraglottic larynx is most often bacterial (supraglottitis / epiglottitis) or traumatic
  • Chronis swelling and edema of the supraglottic larynx is also common after irradiation (Mendenhall 2008)
  • Chronic scarring of the supraglottic larynx is less common and has been reported to result from:
    • Prolonged orotracheal intubation, instrumentation of or trauma to the supraglottic larynx
    • Autoimmune disorders (pemphigoid, SLE, Wegener's granulomatosis, sarcoidosis, relapsing polychondritis)
    • Caustic ingestion
    • Gastro-esophageal reflux disease (Krishna 2006)

Management

Dependent on etiology

  • Medical management (steroids/immunosuppressants)
  • Surgical management (tracheotomy, endoscopic laser resection, supraglottic laryngectomy, thyrotomy or laryngofissure with placement of a keel or stent) (Montgomery 1968)

Laryngeal Stents

  1. Used to keep airway lumen patent after surgical dilation/expansion, reconstruction or trauma
  2. Types of stents:
    • Keel
    • Montgomery
    • Silastic sheet
    • Aboulker
  3. Complications: granulation tissue formation, occlusion, ulceration, infection 

References

Veivers D and Laccourreye: Supracricoid partial laryngecotmy for severe laryngeal stenosis. Arch Otolaryngol Head and Neck Surgery/vol 126, May 2000 pp663-664 

Krishna PD and Malone JP: Ioslated adult suprglottic stenosis: surgical treament and possible etiologies. American Journal of Otolaryngology-Head and Neck Medicine and Surgery 27 (2006) 355-357 

Montgomery WW. The surgical management of supraglottic and subglottic stenosis. Ann Otol Rhinol Laryngol 1968; 77(3):534-46 

Mendenhall WM, Hinerman RW, Amdur RJ et al: Chapter 44 "Larynx" pp 993-994 'Sequelae of Treatment' in Principles and Practice of Radiation Oncology. 5th edition 2008 Lippincott Philadelphia