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Laryngeal Stenosis

Laryngeal Stenoses

Laryngeal stenosis constitutes an acquired or congenital pathology of the larynx, that involves glottic, supraglottic, and/or subglottic restriction, caused by various underlying conditions and events.


Presentation

Various factors can have an effect on the clinical presentation of a patient affected by laryngeal stenosis. It is known that medical history, age, length of the stenosed segment, and general physical condition all influence the final symptomatology.

The most frequent manifestation associated with laryngeal stenosis is stridor, a high-pitched, wheezing sound heard during inhalation or inhalation/ exhalation (biphasic stridor) [1]. The former stridor type is mostly linked to a stenosed glottic or supraglottic region.Stridor is heard when the stenosis has reached approximately 50% of the laryngeal diameter, at which time dyspnea also complicates the clinical picture [2] [3]. Milder narrowing could be marked by a progressively worsening cough. Patients suffering from laryngeal stenosis at the glottic level may also display a hoarse voice, aphonia, dysphagia, hypoxia, cyanosis, and anxiety.

In pediatric patients, laryngeal stenosis may cause no respiratory symptoms at an early stage, but poor appetite and delayed growth may be reported. Recurrent croup is a common finding amongst children affected by laryngeal stenosis of the subglottic area. Congenital laryngeal narrowing tends to present with less alarming symptoms than an acquired stenosis. In addition, children who present with laryngeal stenosis may also have a history of tracheotomy or laryngotracheal reconstruction.

In some cases, the presenting manifestation of laryngeal restriction is severe dyspnea associated with an individual who reports an aggravation of the symptoms following a decannulation/extubation [4].

Hoarseness
  • Patients suffering from laryngeal stenosis at the glottic level may also display a hoarse voice, aphonia, dysphagia, hypoxia, cyanosis, and anxiety.[symptoma.com]
  • Laryngeal stenosis implies a narrowing of the larynx, whether at the supraglottic, glottic, or subglottic level, which may lead to obstructed breathing, dyspnea, and hoarseness.[voiceindy.com]
  • The cardiovascular cause of the hoarseness might be of much higher consequence for the patient as the hoarseness itself, as in the presented case.[hindawi.com]
  • Other problems that affect the throat include Tonsillitis - inflammation of the tonsils Cancer Croup - inflammation, usually in small children, which causes a barking cough Laryngitis - swelling of the voice box, which can cause a hoarse voice or loss[icdlist.com]
  • Symptoms include stridor, wheezing, hoarseness, shortness of breath and respiratory distress. Patients who have severe airway stenosis are often dependent on a tracheotomy tube to breathe.[acclarent.com]
Low Set Ears
  • Individuals with deletions in this region have growth retardation, psychomotor retardation, micrognathia, microcephaly, and apparently low-set ears.[ncbi.nlm.nih.gov]
Long Arm
  • Deletions of the long arm of chromosome 2 are rare. Few cases of interstitial deletions of the 2q33q35 region have been reported.[ncbi.nlm.nih.gov]
Macrocephaly
  • Co-existing diseases Number of children Prematurity 7 Anomaly of facial skeleton, macrocephaly 3 Congenital heart disease, cardiomiopathy 4 Intracerebral haemorrhage, epilepsy, infantile cerebral palsy 9 Hypothyreosis 1 Chromosomal abnormalities 2 Total[czytelniamedyczna.pl]
Blister
  • A skin biopsy specimen showed a subepidermal blister and linear deposits of IgG and C3 at the basement membrane zone of the epidermis.[ncbi.nlm.nih.gov]
  • Epidermolysis bullosa dystrophica is a rare hereditary skin disease of infancy in which minor trauma causes blister formation.[ncbi.nlm.nih.gov]
  • Abstract Pemphigoid is a group of rare, acquired, autoimmune subepithelial blistering diseases. The condition has been subclassified into bullous pemphigoid and cicatricial pemphigoid (CP).[ncbi.nlm.nih.gov]
Skin Lesion
  • Although no new skin lesions appeared, he died of lung carcinoma five months after the tracheostomy.[ncbi.nlm.nih.gov]
Psychomotor Retardation
  • Individuals with deletions in this region have growth retardation, psychomotor retardation, micrognathia, microcephaly, and apparently low-set ears.[ncbi.nlm.nih.gov]

Workup

Manifestations that indicate difficulty in breathing and subsequent oxygenation, such as stridor, cyanosis, and cough should always raise suspicion of laryngeal stenosis. A medical history of intubation or tracheostomy also suggests the possibility of this specific pathology and should be investigated.

With reference to laboratory tests, laryngeal stenosis is normally not diagnosed via blood tests. However, underlying conditions that may predispose the patient to this type of the disorder can be evaluated, such as Wegener's granulomatosis, sarcoidosis, or rheumatoid arthritis. Blood gas analysis can reveal hypoxia in severe cases.

The diagnosis of laryngeal stenosis can be achieved through a multitude of imaging modalities. Plain lateral and anteroposterior neck radiographs can illustrate airway diameter and the extent of the narrowed segment, as well as possible contributing or causing disorders, such as epiglottitis and a retropharyngeal abscess. Thoracic X-ray helps to depict concurrent pathologies of the thorax. The larynx can be evaluated, without the need for general anesthesia, down to the glottic level via flexible fiberoptic endoscopy. Nevertheless, bronchoscopy and direct laryngoscopy constitute the gold standard for the diagnosis [5].

A computerized tomography (CT) scan or a magnetic resonance imaging (MRI) scan are usually not the first-line tools of assessment but can be utilized in the detailed evaluation. The MRI scan precisely illustrates regional vascular anatomy [6].

Laryngeal electromyography and pulmonary function tests can also be employed in the workup procedure [7].

Treatment

  • The method of treatment, and the advantages and disadvantages of the new method of endoscopic treatment of postintubation laryngeal stenosis, are discussed in the article.[ncbi.nlm.nih.gov]
  • […] underwent open laryngoplasty with cartilage graft as first-line treatment.[ncbi.nlm.nih.gov]
  • The causes of the stenosis and the treatment results were different in these subgroups. Treatment resulted in successful decannulation in 22 of 24 infants, and in 5 of 6 children. Treatment included a re-operation in two patients.[ncbi.nlm.nih.gov]
  • Abstract A review of over a century of publication on laryngeal stenosis reveals much about the aetiology and treatment.[ncbi.nlm.nih.gov]
  • Treatment of CP with leflunomide has not been described in the literature until now.[ncbi.nlm.nih.gov]

Prognosis

  • The long-term prognosis for most children is very good, and the successes are emotionally rewarding.[ncbi.nlm.nih.gov]
  • In children with postintubation laryngeal stenosis we frequently find other coexisting general diseases, which have an effect on treatment and on the prognosis in relation to the health of the child. Piśmiennictwo 1.[czytelniamedyczna.pl]
  • The prognosis depends on the underlying disease causing the stenosis. With regard to laryngeal function is often not favorable, some patients can be surgically partially restore them. With this material are reading... My Great Web page Attachments:[eurodoctor.ucoz.com]
  • Prognosis of this syndrome depends on the underlying cardiovascular condition and correction of the underlying cardiac or vascular anomaly is important to a successful recovery.[hindawi.com]

Etiology

  • We studied the influence of various factors on the final outcome including age, sex, etiology, associated conditions, length and diameter of the stenotic segment, as well as its anatomic site.[ncbi.nlm.nih.gov]
  • RESULTS: The etiology of glottic stenosis includes 19 cases due to failed surgery for bilateral vocal fold paralysis; seven cases due to microlaryngoscopy (three laryngeal papilloma, one leukoplakia excision, one glottic cancer excision, one foreign body[ncbi.nlm.nih.gov]
  • The objective of this paper is to study the etiology, age distribution, sex, associated pathologies, location and degree of the laryngeal stenosis.[arquivosdeorl.org.br]
  • [Modern views on etiology, pathogenesis, clinical picture, diagnosis and treatment of laryngeal papillomatosis]. Vestnik otorino laringologii. 2000;1:44-49. Russian. Soldatskiy YL, Onufriyeva EK, Schepin NV. et al.[journals.uran.ua]
  • We present a case report of Ortner’s syndrome of uncommon etiology that illustrates the underlying pathoanatomical mechanisms. 2.[hindawi.com]

Pathophysiology

  • Pathophysiological mechanism of this syndrome is thought to be compression of the left recurrent laryngeal nerve between the aorta and dilated pulmonary artery [ 12 ], and this can be well appreciated from the axial CT images and coronal and sagittal[hindawi.com]

Prevention

  • Case Reports: Four patients, three males and one female, sought expert service with history of ingestion of caustic soda, preventing dyspnea. Tracheostomy was necessary in the female patient.[thieme-connect.com]
  • The keel also has application following hemilaryngectomy to prevent stenosis. The intralaryngeal extension of the keel is thinner than the umbrella of the extralaryngeal portion.[bosmed.com]
  • ALERTA BUBBLE OVERLAY DECUBITUS PREVENTION SYSTEM 17.09.2018 Alerta Bubble – a light-weight and compact overlay alternating pressure relieving mattress system for effective prevention and treatment of patients at low risk of developing a pressure ulcer[medica-tradefair.com]
  • A keel is placed to prevent restenosis in the anterior commissure during reepithelialization. [16] The keel is designed to avoid contact with the posterior glottis to minimize scarring.[emedicine.medscape.com]
  • Yasushi 京都府立医科大学耳鼻咽喉科 Department of Otolaryngology, Kyoto Prefectural University of Medicine 抄録 With the increased awareness of the causes of laryngotracheal stenosis, the early management of the patient with a high risk of developing a stenosis can prevent[ci.nii.ac.jp]

References

Article

  1. Bluestone C, Stool S, Kenna M. Pediatric Otolaryngology. 3rd ed. Philadelphia, PA: WB Saunders Co; 1995. 1275-1286.
  2. Sue RD, Susanto I. Long-term complications of artificial airways. Clin Chest Med. 2003;24(3):457–471.
  3. Nair S, Mohan S, Mandal G, Nilakantan A. Tracheal Stenosis: Our Experience at a Tertiary Care Centre in India with Special Regard to Cause and Management. Indian J Otolaryngol Head Neck Surg. 2014; 66(1): 51–56.
  4. Brichet A, Verkindre C, Dupont J, et al. Multidisciplinary approach to management of postintubation tracheal stenoses. Eur Respir J. 1999;13(4):888–893.
  5. Antón-Pacheco JL, Cano I, García A, et al. Patterns of management of congenital tracheal stenosis. J Pediatr Surg 2003;38:1452-1458.
  6. Schweiger C, Cohen AP, Rutter MJ. Tracheal and bronchial stenoses and other obstructive conditions. J Thorac Dis. 2016; 8(11): 3369–3378.
  7. Boemo RL, Navarrete ML, Genestar EI, Gonzalez M, Fuentes JF, Fortuny P. Interarytenoid osseous bridge after prolonged endotracheal intubation. Acta Otorrinolaringol Esp. 2012;63(6):480-481.

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Last updated: 2019-07-11 21:24