How I Do It: A Novel Technique for Endoscopic Placement of Stent in Management of Anterior Glottic Webs

A Modified Approach for Preventing Anterior Glottic Web Formation Using Mitomycin C in Bilateral Vocal Fold Lesions

Objectives: Laryngeal keel insertion, mucosal suture, application of mitomycin-C (MMC), and staged operations are approaches to prevent the anterior glottic web, but there are limitations. Our study suggests a modified approach to prevent the formation of an anterior glottic web. Methods: This retrospective single-institution tertiary center study (N = 23) involved the simultaneous removal of bilateral vocal fold lesions with topical MMC application. If exudate was identified after 4 to 6 weeks, second laryngomicroscopic surgery (LMS) was performed to remove it with topical MMC application. Extent of anterior glottic web was measured as a percentage of the total length of the membranous vocal fold. Results: After the initial surgery, 18 patients recovered without anterior web or fibrin exudate. Thick exudate was observed in 5 patients. After the second LMS, all patients showed improvement and did not develop anterior web. Conclusion: This modified method has been developed to prevent the anterior glottic web without complications.

A novel puncture needle designed for endoscopic keel placement to treat anterior glottic webs

BACKGROUND

Endoscopic keel placement is difficult for patients with poor laryngeal exposures.

AIMS/OBJECTIVES

To introduce a novel extra-endo laryngeal puncture technique for endoscopic keel placement to manage anterior glottic webs.

MATERIAL AND METHODS

Patients with anterior glottic webs and difficult laryngeal exposure in our hospital during 2018 to 2020 were recruited in this study. After the incision of the web, a novel puncture needle modified from a maxillary sinus puncture needle was inserted into endolarynx, and could pull the suture passing along a keel from inside out. The suture was then fixated on the neck, and the keel was placed for 4 weeks. Patients were followed up for at least 1 year.

RESULTS

Eight patients including three men and five women were included in this study. All the patients tolerated the silicone keel well, and 7 of 8 (87.5%) patients did not have web relapses and reached remarkable voice improvements during follow-up. None of the cases needed a tracheotomy due to the dyspnea postoperatively.

CONCLUSIONS AND SIGNIFICANCE

The novel puncture technique is an easy and effective approach to facilitate endoscopic keel placement for the treatment of anterior glottic webs and other surgical procedures requiring endolaryngeal suturing.

Subglottic Mucosal Flap: Endoscopic Single-Stage Reconstruction for Anterior Glottic Stenosis

OBJECTIVES/HYPOTHESIS

Anterior glottic stenosis (AGS) results from surgical intervention, carcinoma, papillomatosis, congenital, or idiopathic causes. It may be present as elastic web or fibrotic scar. It impairs vocal function and glottic airway. Reconstructive options include resection and placement of a keel or glottic web-based mucosal flaps to prevent restenosis. These methods may not be sufficient for reconstructing a thick anterior scar and may require multiple interventions. The aim of the study was to describe the anterior subglottic mucosal flap (ASGMF), a one-stage, keel-free technique for AGS repair.

STUDY DESIGN

A retrospective cohort.

METHODS

Patients with AGS were operated using the ASGMF between 2017 and 2020. The stenotic segment was excised, and then an ASGMF was developed. A unilateral oblique incision was performed to allow rotation and advancement of the flap toward the contralateral vocal fold. The flap was sutured to the mucosal edge of the vocal fold to create mucosal continuity and prevent restenosis. Vocal fold length ratio (VFLR), which is between the free part and the total vocal fold length, as well as stroboscopic measures, were calculated before and after surgery.

RESULTS

Twelve patients were enrolled. Etiologies were iatrogenic, dysplasia, papillomatosis, carcinoma, and congenital. Average VFLR improved from 0.33 to 0.87 (P-value < .0001). Median amplitude and mucosal wave propagation improved from 12.3% and 9.5% to 28.6% and 22.7%, respectively (P-values = .0278, .0385). Phase symmetry improved from 24.5% to 60.9% (P-value = .0413). No complications were encountered.

CONCLUSIONS

ASGMF for AGS is an effective surgical procedure, allowing for one stage, keel-free reconstruction of the anterior commissure. ASGMF can significantly elongate the free portion of the vocal folds and improve vibratory function.

LEVEL OF EVIDENCE

4 Laryngoscope, 2021.