Ihab Atallah1,2, M Krishniah Manjunath1,3, Ahmad Al Omari1,4, Christian Adrien Righini2, Paul F Castellanos1. 1. Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A. 2. Otolaryngology-Head and Neck Surgery Department, Grenoble University Hospital, Grenoble, France. 3. Department of Surgery, Colombia Asia Referral Hospital, Yeshwanthpur, Bangalore, India. 4. Division of Otolaryngology, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Abstract
OBJECTIVES/HYPOTHESIS: To demonstrate that reconstructive transoral laser microsurgical (R-TLM) techniques can be used for the treatment of symptomatic laryngeal posterior glottic web-based stenosis (PGWS) in a large cohort of patients utilizing a postcricoid mucosal advancement flap (PCMAF). STUDY DESIGN: Retrospective cohort review. METHODS: A consecutive series of patients with PGWS who underwent R-TLM using a PCMAF were reviewed for outcomes. After laser excision of the PGWS scar and mobilization of fixed cricoarytenoid joints, a PCMAF was raised using microinstruments and a scanning free-beam CO2 laser. The flap was advanced and attached over the scar bed using a technique with multiple novel features that make it easy to adopt. RESULTS: Fifty-two patients were treated. Of the cases, 42.3% had a tracheostomy at presentation with grade II to IV PGWS, and 46% of cases had grade III to IV PGWS. In all cases, R-TLM was the only treatment approach. No open reconstructions were performed. No airway stents were used. Patients without tracheostomy, regardless of the grade of stenosis, did not require a tracheostomy to undergo this operation. All tracheostomy patients were successfully decannulated. All patients without a tracheostomy had significant improvement of their respiratory symptoms on the Dyspnea Index (mean Δ = 14.75, P value <.01). CONCLUSIONS: RTLM using the PCMAF is a feasible, safe, and effective alternative to open approaches for airway reconstruction for PGWS. This novel transoral technique includes a much simpler endoscopic suturing alternative to knot tying among other new features. It is reproducible and reliable for laryngologists familiar with laryngeal microsurgery. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:685-690, 2017.
OBJECTIVES/HYPOTHESIS: To demonstrate that reconstructive transoral laser microsurgical (R-TLM) techniques can be used for the treatment of symptomatic laryngeal posterior glottic web-based stenosis (PGWS) in a large cohort of patients utilizing a postcricoid mucosal advancement flap (PCMAF). STUDY DESIGN: Retrospective cohort review. METHODS: A consecutive series of patients with PGWS who underwent R-TLM using a PCMAF were reviewed for outcomes. After laser excision of the PGWS scar and mobilization of fixed cricoarytenoid joints, a PCMAF was raised using microinstruments and a scanning free-beam CO2 laser. The flap was advanced and attached over the scar bed using a technique with multiple novel features that make it easy to adopt. RESULTS: Fifty-two patients were treated. Of the cases, 42.3% had a tracheostomy at presentation with grade II to IV PGWS, and 46% of cases had grade III to IV PGWS. In all cases, R-TLM was the only treatment approach. No open reconstructions were performed. No airway stents were used. Patients without tracheostomy, regardless of the grade of stenosis, did not require a tracheostomy to undergo this operation. All tracheostomy patients were successfully decannulated. All patients without a tracheostomy had significant improvement of their respiratory symptoms on the Dyspnea Index (mean Δ = 14.75, P value <.01). CONCLUSIONS: RTLM using the PCMAF is a feasible, safe, and effective alternative to open approaches for airway reconstruction for PGWS. This novel transoral technique includes a much simpler endoscopic suturing alternative to knot tying among other new features. It is reproducible and reliable for laryngologists familiar with laryngeal microsurgery. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:685-690, 2017.