Laser bronchoscopy with transglottic/supraglottic ventilation to relieve dysphonia and subglottic obstruction.
Dysphonia after endotracheal intubation usually indicates a glottic lesion but it can also herald an obstructing subglottic airway mass. Outpatient strobovideolaryngoscopy may be anatomically extended by transglottic videotracheobronchoscopy to achieve a thorough examination of the proximal bronchi, trachea, subglottis, glottis, and supraglottis in selected cases. Combining these techniques with lateral soft tissue x-ray studies of the neck in two patients with dysphonia and stridor, nearly identical postendotracheal intubation subglottic severely obstructing granulation "tumors" were diagnosed. Operative subglottic resection with a rigid ventilating laser bronchoscope combined with transglottic/supraglottic anesthetic ventilation techniques and contact-tip Nd-YAG laser phototherapy relieved the dysphonia and airway obstruction simultaneously. Normal vocal quality and full anatomical airway patency were achieved in both cases. Follow-up postoperative vocal rehabilitation and medical therapy sustained the surgical results.
Gallivan
G J
GJ
Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Gallivan
K H
KH
Belmonte
R S
RS
D000368:Aged; D000402:Airway Obstruction / Q000534:rehabilitation* / Q000601:surgery*; D000772:Anesthesia, Local; D001999:Bronchoscopy; D049669:History, 16th Century; D049670:History, 17th Century; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D007828:Laryngoscopy; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D009126:Muscle Relaxation; D010789:Phototherapy; D012121:Respiration, Artificial / Q000266:history; D014832:Voice Disorders / Q000534:rehabilitation* / Q000601:surgery*