title: Reconstructive transoral laser microsurgery for posterior glottic web with stenosis.
abstract: To demonstrate that reconstructive transoral laser microsurgical (R-TLM) techniques can be used for the treatment of symptomatic laryngeal posterior glottic web-based stenosis (PGWS) in a large cohort of patients utilizing a postcricoid mucosal advancement flap (PCMAF).
  
  
  
  Retrospective cohort review.
  
  
  
  A consecutive series of patients with PGWS who underwent R-TLM using a PCMAF were reviewed for outcomes. After laser excision of the PGWS scar and mobilization of fixed cricoarytenoid joints, a PCMAF was raised using microinstruments and a scanning free-beam CO2laser. The flap was advanced and attached over the scar bed using a technique with multiple novel features that make it easy to adopt.
  
  
  
  Fifty-two patients were treated. Of the cases, 42.3% had a tracheostomy at presentation with grade II to IV PGWS, and 46% of cases had grade III to IV PGWS. In all cases, R-TLM was the only treatment approach. No open reconstructions were performed. No airway stents were used. Patients without tracheostomy, regardless of the grade of stenosis, did not require a tracheostomy to undergo this operation. All tracheostomy patients were successfully decannulated. All patients without a tracheostomy had significant improvement of their respiratory symptoms on the Dyspnea Index (mean Δ = 14.75, P value <.01).
  
  
  
  RTLM using the PCMAF is a feasible, safe, and effective alternative to open approaches for airway reconstruction for PGWS. This novel transoral technique includes a much simpler endoscopic suturing alternative to knot tying among other new features. It is reproducible and reliable for laryngologists familiar with laryngeal microsurgery.
  
  
  
  4. Laryngoscope, 127:685-690, 2017.
authors.affiliation: Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.|Otolaryngology-Head and Neck Surgery Department, Grenoble University Hospital, Grenoble, France.
authors.forename: Ihab
authors.initials: I
authors.lastname: Atallah
authors.affiliation: Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.|Department of Surgery, Colombia Asia Referral Hospital, Yeshwanthpur, Bangalore, India.
authors.forename: M Krishniah
authors.initials: MK
authors.lastname: Manjunath
authors.affiliation: Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.|Division of Otolaryngology, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Ahmad Al
authors.initials: AA
authors.lastname: Omari
authors.affiliation: Otolaryngology-Head and Neck Surgery Department, Grenoble University Hospital, Grenoble, France.
authors.forename: Christian Adrien
authors.initials: CA
authors.lastname: Righini
authors.affiliation: Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Castellanos
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007828:Laryngoscopy / Q000379:methods; D007829:Laryngostenosis / Q000175:diagnosis / Q000601:surgery*; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods; D061214:Patient Safety; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013524:Surgical Flaps / Q000637:transplantation; D013536:Suture Techniques; D014139:Tracheostomy / Q000379:methods; D016896:Treatment Outcome
keywords: CO2 laser; Posterior glottic web; airway surgery; endoscopic surgery; intubation injury; laryngeal stenosis; minimally invasive surgery; natural orifice surgery; postcricoid mucosal advancement flap; transoral surgery; vascular clips