International Journal of Head and Neck Surgery

Register      Login

VOLUME 13 , ISSUE 1 ( January-March, 2022 ) > List of Articles


Posterior Glottic Stenosis: A Review of Surgical Management Outcomes

Taylor G Lackey, Carolyn A Chabuz, Daniel S Fink

Keywords : Adult, Posterior glottic stenosis, Swallowing, Surgical outcomes, Voice

Citation Information : Lackey TG, Chabuz CA, Fink DS. Posterior Glottic Stenosis: A Review of Surgical Management Outcomes. Int J Head Neck Surg 2022; 13 (1):47-54.

DOI: 10.5005/jp-journals-10001-1524

License: CC BY-NC 4.0

Published Online: 25-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


The objective of this review is to describe management options and their success in adults with acquired posterior glottic stenosis (PGS). Literature from PubMed search engine was reviewed, including recent and historical reports covering etiology, surgical techniques, and voice and swallowing outcomes in PGS. Damage to the posterior commissure after intubation is still the most common etiology for acquired PGS, with patients presenting with dyspnea weeks to months after injury. There is a multitude of surgical techniques described, regardless of the technique chosen, PGS is a challenging disease that often requires more than one procedure. Tracheostomy should be considered to secure the airway in the perioperative period, and decannulation is typically successful. Swallowing dysfunction is often temporary, and voice is often stable or improved after surgical intervention. As the laryngologist will continue to face this disease, especially with the recent pandemic, being familiar with various techniques options will be important in providing a safe and functional larynx.

  1. Benjamin B, Holinger LD. Laryngeal complications of endotracheal anesthesia. Ann Otol Rhinol Laryngol 2008;117(9)Suppl 200:1–20. DOI: 10.1177/00034894081170S901
  2. Allen TH, Steven IM. Prolonged endotracheal intubation in infants and children. Br J Anaesth 1965;37(8):566–573. DOI: 10.1093/bja/37.8.566
  3. Benjamin B. Prolonged intubation injuries of the larynx: endoscopic diagnosis, classification, and treatment*. Ann Otol Rhinol Laryngol 1993;127(8):492–507. DOI: 10.1177/0003489418790348
  4. Walner DL, Loewen MS, Kimura RE. Neonatal subglottic stenosis–incidence and trends. Laryngoscope 2001;111(1):48–51. DOI: 10.1097/00005537-200101000-00009
  5. Hyattsville. COVID-19 Case surveillance Public Used Data with Geography. National Center for Health Statistics. Accessed April 5, 2021.
  6. Fried MW, Crawford JM, Mospan AR, et al. Patient characteristics and outcomes of 11 721 patients with coronavirus disease 2019 (covid-19) hospitalized across the United States. Clin Infect Dis 2021;72(10):e558–e565. DOI: 10.1093/cid/ciaa1268
  7. Whited RE. Posterior commissure stenosis post long-term intubation. Laryngoscope 1983;93(10):1314–1318. DOI: 10.1002/lary. 1983.93.10.1314
  8. Irving RM, Bailey CM, Evans JNG. Posterior glottic stenosis in children. Int J Pediatr Otorhinolaryngol 1993;28(1):11–23. DOI: 10.1016/0165–5876(93)90142–p
  9. Perkins JA, Inglis AF, Richardson MA. Latrogenic airway stenosis with recurrent respiratory papillomatosis. Arch Otolaryngol Head Neck Surg 1998;124(3):281–287. DOI: 10.1001/archotol.124.3.281
  10. Zampeli E, Moutsopoulos HM. Relapsing polychondritis: a diagnosis not to be missed. Rheumatology (Oxford) 2018;57(7):1768. DOI: 10.1093/rheumatology/key124
  11. Gross WL, Trabandt A, Csernok E. Pathogenesis of Wegener's granulomatosis. Ann Med Interne 1998;149(5):280–286. PMID: 9791561.
  12. Djalilian M, Mcdonald TJ, Devine KD, et al. Nontraumatic, nonneoplastic subglottic stenosis. Ann Otol Rhinol Laryngol 1975;84(6):757–763. DOI: 10.1177/000348947508400605
  13. Gardner GM. Posterior glottic stenosis and bilateral vocal fold immobility: diagnosis and treatment. Otolaryngol Clin North Am 2000;33(4):855–877. DOI: 10.1016/s0030-6665(05)70248-6
  14. Whited RE. A prospective study of laryngotracheal sequelae in long-term intubation. Laryngoscope 1984;94(3):367–377. DOI: 10.1288/00005537-198403000-00014
  15. Ellis PDM, Bennett J. Laryngeal trauma after prolonged endotracheal intubation. J Laryngol Otol 1977;91(1):69–74. DOI: 10.1017/S0022215100083365
  16. Volpi D, Kuriloff DB, Lin PT, et al. Risk factors for intubation injury of the larynx. Ann Otol Rhinol Laryngol 1987;96(6):684–686. DOI: 10.1177/000348948709600614
  17. Hillel AT, Karatayli-Ozgursoy S, Samad I, et al. Predictors of posterior glottic stenosis: a multi-institutional case-control study. Ann Otol Rhinol Laryngol 2016;125(3):257–263. DOI: 10.1177/0003489415608867
  18. Katsantonis NG, Kabagambe EK, Wootten CT, et al. Height is an independent risk factor for postintubation laryngeal injury. Laryngoscope 2018;128(12):2811–2814. DOI: 10.1002/lary.27237
  19. Vahidi N, Wang L, Moore J. Posterior glottic stenosis type I: clinical presentation and postoperative course. Ear Nose Throat J 2020:1–4. DOI: 10.1177/0145561320908482
  20. Verma SP, Smith ME, Dailey SH. Transnasal tracheoscopy. Laryngoscope 2012;122(6):1326–1330. DOI: 10.1002/lary.23221
  21. Weddell G, Feinstein B, Pattle RE. The electrical activity of voluntary muscle in man under normal and pathologic conditions. Brain 1944;67:178–257. DOI: 10.1093/brain/67.3.178
  22. Bogdasarian RS, Olson NR. Posterior glottic stenosis. Oper Tech Otolaryngol Head Neck Surg 1980;88(6):765–772. DOI: 10.1177/019459988008800625
  23. Riffat F, Palme CE, Veivers D. Endoscopic treatment of glottic stenosis: A report on the safety and efficacy of CO2 laser. J Laryngol Otol 2012;126(5):503–505. DOI: 10.1017/S002221511100301X
  24. Qazi S, Mau T, Tibbetts KM. Impact of patient factors and management strategies on outcomes after transverse posterior cordotomy. Laryngoscope 2021;131(5):1066–1070. DOI: 10.1002/lary.28931
  25. Ghodke A, Tracy LF, Hollis A, et al. Combined transverse cordotomy–anteromedial arytenoidectomy for isolated glottic stenosis. Laryngoscope 2021;131(10):1–7. DOI: 10.1002/lary.29438
  26. Maeso-Plaza A, Dablanca-Blanco M, Ortega-Fernandez C, et al. Cicatricial posterior glottic stenosis. Our experience. Acta Otorrinolaringol Esp 2016;67(6):330–338. DOI: 10.1016/j.otorri.2016.01.008
  27. Meyer TK, Wolf J. Lysis of interarytenoid synechia (type I posterior glottic stenosis): vocal fold mobility and airway results. Laryngoscope 2011;121(10):2165–2171. DOI: 10.1002/lary.22036
  28. Gallivan GJ. Bilateral vocal fold posterior glottic/subglottic stenotic web resected with contact tip Nd-YAG laser. J Voice 2002;16(3): 415–421. DOI: 10.1016/S0892–1997(02)00113–3
  29. Rovó L, Venczel K, Torkos A, et al. Endoscopic arytenoid lateropexy for isolated posterior glottic stenosis. Laryngoscope 2008;118(9): 1550–1555. DOI: 10.1097/MLG.0b013e31817c0b32
  30. Wolf M, Primov-Fever A, Talmi YP, et al. Posterior glottic stenosis in adults. Isr Med Assoc J 2007;9(8):597–599. PMID: 17877066.
  31. Liu BP, Bové MJ, Nemeth AJ. Posterior glottic stenosis with a calcified interarytenoid scar band: CT and laryngoscopic correlation. Am J Neuroradiol 2010;31(10):1969–1971. DOI: 10.3174/ajnr.A1980
  32. Strong MS, Healy GB, Vaughan CW, et al. Endoscopic management of laryngeal stenosis. Otolaryngol Clin North Am 1979;12(4):797–805. PMID: 120520.
  33. Rosen CA, Wang H, Cates DJ, et al. The glottis is not round: Teardrop-shaped glottic dilation for early posterior glottic stenosis. Laryngoscope 2019;129(6):1428–1432. DOI: 10.1002/lary.27594
  34. Sztanõ B, Szakács L, Madani S, et al. Comparison of endoscopic techniques designed for posterior glottic stenosis - a cadaver morphometric study. Laryngoscope 2014;124(3):705–710. DOI: 10.1002/lary.24270
  35. Rovo L, Jori J, Brzozka M, Czigner J. Minimally invasive surgery for posterior glottic stenosis. Otolaryngol Head Neck Surg 1999;121(1):153–156. DOI: 10.1016/S0194–5998(99)70145–2
  36. Atallah I, Manjunath MK, Omari A Al, et al. Reconstructive transoral laser microsurgery for posterior glottic web with stenosis. Laryngoscope 2017;127(3):685–690. DOI: 10.1002/lary.26212
  37. Dedo HH, Sooy CD. Endoscopic laser repair of posterior glottic, subglottic and tracheal stenosis by division or micro-trapdoor flap. Laryngoscope 1984;94(4):445–450. DOI: 10.1288/00005537-198404000-00001
  38. Yılmaz T, Süslü N, Günaydın RÖ, et al. Microtrapdoor flap technique for treatment of glottic laryngeal stenosis: experience with 34 cases. J Voice 2016;30(6):751–754. DOI: 10.1016/j.jvoice.2015.08.001
  39. Beste DJ, Toohill RJ. Microtrapdoor flap repair of laryngeal and tracheal stenosis. Ann Otol Rhinol Laryngol 1991;100(5 pt 1):420–423. DOI: 10.1177/000348949110000513
  40. Duncavage JA, Piazza LS, Ossoff RH, et al. The microtrapdoor technique for the management of laryngeal stenosis. Laryngoscope 1997;97 (7 pt 1):825–828. DOI: 10.1288/00005537-198707000-00009
  41. Damrose EJ, Beswick DM. Repair of posterior glottic stenosis with the modified endoscopic postcricoid advancement flap. Otolaryngol - Head Neck Surg (United States) 2016;154(3):568–571. DOI: 10.1177/0194599815622626
  42. Semmler M, Keck T, Reiter R, et al. Endolaryngeal posterior mucosal flap for surgical repair of posterior glottic stenosis. Auris Nasus Larynx 2011;38(5):608–611. DOI: 10.1016/j.anl.2010.12.016
  43. Weidenbecher M. Repair of high-grade posterior glottic stenosis: A novel criocarytenoid joint release technique. Laryngoscope 2018;128(7):1639–1642. DOI: 10.1002/lary.27092
  44. Atallah I, MK M, Al Omari A, et al. Cricoarytenoid joint ankylosis: classification and transoral laser microsurgical treatment. J Voice 2019;33(3):375–380. doi:10.1016/j.jvoice.2017.11.020
  45. Dennis DP, Kashima H. Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol 1989;98(12 pt 1):930–934. DOI: 10.1177/000348948909801203
  46. Lim RY. Endoscopic CO2 laser arytenoidectomy for postintubation glottis stenosis. Otolaryngol Head Neck Surg 1991;105(5):662–666. DOI: 10.1177/019459989110500505
  47. Yawn RJ, Daniero JJ, Gelbard A, et al. Novel application of the Sonopet for endoscopic posterior split and cartilage graft laryngoplasty. Laryngoscope 2016;126(4):941–944. DOI: 10.1002/lary.25596
  48. Matsushima K, Matsuura K, Takeda T, et al. Transcricothyroid endoscopic subglottic surgery for posterior glottic stenosis: a case report. J Voice 2017;31(5):634–637. DOI: 10.1016/j.jvoice.2017.02.005
  49. Mau T, Pletcher SD, Cavanagh PW, et al. Minicricothyrotomy approach with fiberoptic guidance for management of posterior glottic stenosis. Laryngoscope 2007;117(8):1488–1490. DOI: 10.1097/MLG.0b013e318063e88c
  50. Hoasjoe DK, Franklin SW, Aarstad RF, et al. Posterior glottic stenosis mechanism and surgical management. Laryngoscope 1997;107(5):675–679. DOI: 10.1097/00005537-199705000-00022
  51. Thomé R, Thomé DC, Behlau M. The use of buccal mucosa graft at posterior cricoid splitting for subglottic stenosis repair. Laryngoscope 2001;111(12):2191–2194. DOI: 10.1097/00005537- 200112000-00023
  52. Schaefer SD, Close LG, Brown OE. Mobilization of the fixated arytenoid in the stenotic posterior laryngeal commissure. Laryngoscope 1986;96(6):656–659. DOI: 10.1288/00005537- 198606000-00012
  53. Goodwin WJ, Isaccson G, Kirchner JC, et al. Vocal cord mobilization by posterior laryngoplasty. Laryngoscope 1988;98(8 Pt 1):846–848. DOI: 10.1288/00005537-198808000-00011
  54. Nouraei SAR, Dorman EB, Vokes DE. Management of posterior glottic stenosis using the combined glottic reconstruction procedure. Clin Otolaryngol 2018;43(5):1415–1418. DOI: 10.1111/coa.13154
  55. Snow GE, Shaver TB, Teplitzky TB, et al. Predictors of tracheostomy decannulation in adult laryngotracheal stenosis. Otolaryngol - Head Neck 2020;164(6):1265–1271. DOI: 10.1177/0194599820978276
  56. Kremer C, Jiang R, Singh A, et al. Factors affecting posterior glottic stenosis surgery outcomes: systematic review and meta-analysis. Ann Otol Rhinol Laryngol 2021;130(10):1156–1163. DOI: 10.1177/0003489421997278
  57. Whited CW, Dailey SH. Is mitomycin C useful as an adjuvant therapy in endoscopic treatment of laryngotracheal stenosis? Laryngoscope 2015;125(10):2243–2244. DOI: 10.1002/lary.25364
  58. Fawaz SA, Sabri SM, Sweed AS, et al. Use of local mitomycin C in enhancing laryngeal healing after laser cordotomy; A prospective controlled study. Head Neck 2014;36(10):1248–1252. DOI: 10.1002/hed.23440
  59. Bertelsen C, Shoffel-Havakuk H, O'Dell K, et al. Serial in-office intralesional steroid injections in airway stenosis. JAMA Otolaryngol Head Neck Surg 2018;144(3):203–210. DOI: 10.1001/jamaoto. 2017.2800
  60. Langman AW, Lee KC, Dedo HH. The endoscopic teflon keel for posterior and total glottic stenosis. Laryngoscope 1989;99(6):571–577. DOI: 10.1288/00005537-198906000-00001
  61. Zeitels SM, Lombardo P, Chaves JL, et al. Glottic stenosis: an anatomic analysis and new treatment with a self-retaining interarytenoid spring. Ann Otol Rhinol Laryngol 2019;128(3_suppl):94S–105S. DOI: 10.1177/0003489418802284
  62. Goldberg AN. Head and neck and plastic surgery a targeted problem and its solution endoscopic postcricoid advancement flap for posterior glottic stenosis. 2000;(March):1998–2001.
  63. Hatcher JL, Dao AM, Simpson CB. Voice outcomes after endoscopic treatment of laryngotracheal stenosis. Ann Otol Rhinol Laryngol 2015;124(3):235–239. DOI: 10.1177/0003489414551980
  64. Conklin M, Clary MS, Cuadrado EM, et al. Effect of unilateral cordotomy on perception of dysphagia. Ann Otol Rhinol Laryngol 2020;129(6):536–541. DOI: 10.1177/0003489419898711
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.