title: Laryngotracheal paratubal air envelope: a useful sign in voice and airway reconstructive surgery.
abstract: Aphonia, dysphonia, and laryngotracheal stenosis with upper airway compromise are diagnosed with increasing frequency. Endoscopic surgical reconstructive techniques accompanied by tracheal T-tube stenting successfully restore voice, airway function, and structure. Timing of tracheal T-tube removal remains controversial, particularly when the tip of the upper arm of the optimally sized T-tube is placed in a critical supraglottic position. The appearance of an air envelope, manifested as linear air densities between the outside wall of the T tube and the inside wall of the larynx and trachea, has proven to be a useful and reliable indicator of laryngotracheal structural integrity and functional stability. The paratubal air envelope sign is demonstrated by soft-tissue neck radiographs and delta scan topograms. This objective sign, videolaryngoscopy/stroboscopy, and clinical judgment combine to determine optimal timing for tracheal T-tube removal.
authors.affiliation: Tufts University School of Medicine, Springfield, Massachusetts.
authors.forename: G J
authors.initials: GJ
authors.lastname: Gallivan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005931:Glottis / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007828:Laryngoscopy; D007829:Laryngostenosis; D008297:Male; D012123:Pulmonary Ventilation; D015607:Stents; D013518:Surgery, Plastic; D014132:Trachea / Q000503:physiopathology / Q000601:surgery; D014140:Tracheotomy; D014827:Vocal Cords / Q000503:physiopathology / Q000601:surgery*; D014832:Voice Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*