Laser bronchoscopy with transglottic/supraglotticventilation to relieve dysphonia and subglottic obstruction |
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Authors: | Gregory J. Gallivan K. Holly Gallivan Raymond S. Belmonte |
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Affiliation: | aAttending Thoracic and Airway Reconstructive Surgeon and Voice Care Specialist, Springfield, Massachusetts, USA;*Surgical Resident, Thomas Jefferson University, Philadelphia, Pennsylvania, USA;†Attending Anesthesiologist, Chicago, Illinois; U.S.A. |
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Abstract: | Dysphonia after endotracheal intubation usually indicates a glotticlesion but it can also herald an obstructing subglottic airway mass. Outpatient strobovideolaryngoscopy may be anatomically extended by transglottic videotracheobronchoscopy to achieve a thorough examination of the proximal bronchi, trachea, subglottis, glottis, and supraglottis in selected cases. Combining these techniques with lateral soft tissue x-ray studies of the neck in two patients with dysphonia and stridor, nearly identical postendotracheal intubation subglottic severely obstructing granulation “tumors” were diagnosed. Operative subglottic resection with a rigid ventilating laser bronchoscope combined with transglottic/supraglottic anesthetic ventilation techniques and contact-tip Nd-YAG laser phototherapy relieved the dysphonia and airway obstruction simultaneously. Normal vocal quality and full anatomical airway patency were achieved in both cases. Follow-up postoperative vocal rehabilitation and medical therapy sustained the surgical results. |
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Keywords: | Dysphonia Endotracheal intubation Strobovideolaryngoscopy Videotracheobronchoscopy Bronchi Trachea Subglottis Glottis Supraglottis Stridor Granulation tumor Supraglottic anesthetic ventilation Contact tip Nd-YAG laser phototherapy Airway obstruction |
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