Endoscopic laser repair of posterior glottic, subglottic and tracheal stenosis by division or micro-trapdoor flap.

Laryngeal and tracheal stenosis have been refractory to a wide variety of treatments including dilation, stents, or have required major open operation, e.g., laryngofissure with and without skin or mucosal grafts and segmental resection with larynx release. Adequate airway even when achieved was frequently at the expense of voice quality and significant morbidity or mortality. A new highly successful endoscopic technique is described for the treatment of posterior glottic stenosis (apparent bilateral vocal cord paralysis), subglottic stenosis, and tracheal stenosis up to 1 cm thick. The procedure involves the endoscopic use of the CO2 laser, and a micro-trapdoor mucosal flap. Ninety percent of the patients in the group studied obtained an adequate airway with good voice quality and no tracheotomy was required in those patients not already having one. In 19 patients there was no mortality and essentially no morbidity.