title: Posterior glottic stenosis in adults.
abstract: BACKGROUND
  Posterior glottic stenosis is a complication of prolonged intubation, manifesting as airway stenosis that may mimic bilateral vocal cord paralysis. It presents a variety of features that mandate specific surgical interventions.
  
  
  OBJECTIVE
  To summarize our experience with PSG and its working diagnosis.
  
  
  METHODS
  We conducted a retrospective review of a cohort of adult patients with PGS operated at the Sheba Medical Center between 1994 and 2006.
  
  
  RESULTS
  Ten patients were diagnosed with PGS, 6 of whom also had stenosis at other sites of the larynx and trachea. Since 2000, all patients underwent laryngeal electromyographic studies and direct laryngoscopy prior to surgery. Surgical interventions included endoscopic laser procedures (in 2 patients), laryngofissure and scar incision (in 1), laryngofissure with buccal mucosa grafting (in 3) or with costal cartilage grafting (in 1) and laryngofissure with posterior cricoid split and stenting (in 1); one patient was not suitable for surgery. Postoperative follow-up included periodic fiberoptic endoscopies. Voice analysis was evaluated by the GRBAS grading. Seven patients were successfully decannulated within one to three procedures. Voice quality was defined as good in 7 patients, serviceable in 2 and aphonic in 1.
  
  
  CONCLUSIONS
  Posterior glottic stenosis may be isolated or part of complex laryngotracheal pathologies. Electromyographic studies and direct laryngoscopy must be included in the diagnostic workup. Costal cartilage or buccal mucosa grafts are reliable, safe and successful with respect to graft incorporation and subglottic remodeling.
authors: Department of Otorhinolaryngology & Head Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel. wolfm@post.tau.ac.il
authors: Michael
authors: M
authors: Wolf
authors: Adi
authors: A
authors: Primov-Fever
authors: Yoav P
authors: YP
authors: Talmi
authors: Jona
authors: J
authors: Kronenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic; D004576:Electromyography; D005260:Female; D005931:Glottis / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D012189:Retrospective Studies; D014833:Voice Quality