Glottic Airway Stenosis
The larynx forms the narrowest part of the central respiratory tract. As a result, anatomical or neurogenic changes can easily lead to clinically significant airway narrowing.
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Glottic Airway Stenosis Hans Edmund Eckel and György Lichtenberger†
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larynx forms the narrowest part of the central respiratory tract. As a result, anatomical or neurogenic changes can easily lead to clinically significant airway narrowing. Glottic airway stenosis most frequently arises from bilateral vocal cord immobility caused by recurrent laryngeal nerve injury. Previous surgery, mostly thyroid surgery, is the most common cause of laryngeal nerve paral ysis. The diagnostic protocol includes detailed history-taking, inspection, palpation, zoom laryngoscopy and/or transnasal flexible laryngoscopy, thyroid gland workup, stroboscopy, microlaryngoscopy, pharyngoesophagoscopy, tracheobronchoscopy, and suspension laryngoscopy with tactile assessment of arytenoid cartilage mobility. Ultrasonography of the neck, video-fluoroscopy, magnetic resonance imaging studies of the brain, computed tomography scans of the thorax and lateral skull base, and specific laboratory tests should be performed when needed. The flow–volume curve, peak expiratory flow (PEF), peak inspiratory flow (PIF), and total airway resistance are the standard function tests for diagnosing central airway obstruction. PEF and PIF seem to be the best suitable follow-up
H. E. Eckel (*) Department of Oto-Rhino-Laryngology, A.ö. Landeskrankenhaus Klagenfurt, HNO, St. Veiter Str. 47, A-9020 Klagenfurt, Austria e-mail: [email protected]
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parameters to assess airway mechanics before and after surgical procedures. A variety of endoscopic procedures are available for treatment. The most important ones are arytenoidectomy, cordectomy, posterior cordectomy, temporary lateral fixation of the vocal cord, and definitive lateralization of the vocal.
9.1 Anatomical Background Because of its dual functions in preventing aspiration and producing speech, the larynx must be able to close the airway temporarily during deglutition. Disturbances of this physiological process can lead to permanent narrowing of the airway lumen. Inflam matory swelling, scarring, movement disorders of the vocal cords, and tumor masses can narrow or obstruct the airway. The larynx forms the narrowest part of the central respiratory tract. As a result, anatomical or neurogenic changes can easily lead to clinically significant airway narrowing. The relative narrowness of the respiratory tract at this level is based on the physiological function of the larynx as a safety valve between the upper respiratory and alimentary tracts. In adults, the airway lumen at the level of the trachea is 300–500 mm2, the subglottic airway measures approximately 200–300 mm2. and the glottic airway (with abducted vocal cords) 150–200 mm2. With bilateral vocal cord paralysis, the glottic airway is reduced to 30–60 mm2, measuring only some 20–30% of the glottic airway in healthy individuals (Fig. 9.1) [1, 2].
M. Remacle, H. E. Eckel (eds.), Surgery of Larynx and Trachea, DOI: 10.1007/978-3-540-79136-2_9, © Springer-Verlag Berlin Heidelberg 2010
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