Management of Posterior Glottic Stenosis: A Systematic Review.

Abstract

Objective: To review the current literature about surgical management and postoperative outcomes of posterior glottic stenosis (PGS).

Data sources: PubMED, Scopus, and Cochrane Library.

Methods: Three investigators conducted a comprehensive review of the literature related to the epidemiology, etiologies, and management of adult patients with PGS through the PRISMA statements.

Results: Twenty-eight retrospective studies met our inclusion criteria, accounting for 502 patients. Prolonged intubation (51.8%) was the most prevalent etiology. PGS required immediate tracheotomy in 57.6% of the cases. The mean postsurgery decannulation mean rate was 79.6%, ranging from 61.5% to 100% regarding procedures. There was a myriad of procedures used, the most common including postcricoid mucosa advancement flap, arytenoidectomy, and synechia incision. Voice, swallowing, and airway outcomes significantly improved in most studies following surgery. There was a substantial heterogeneity between studies in the PGS diagnosis, the procedure definition and technical features, and the postoperative outcomes. A few studies used objective airway and voice quality measurements to investigate the procedure effectiveness.

Conclusion: The management of PGS is associated with satisfactory decannulation rates and subjective improvements in voice and swallowing across various surgical procedures. However, this review highlights significant limitations, including the lack of controlled studies comparing these techniques and the overall low evidence level of existing research. Future consensus guidelines are needed for defining surgical procedures and determining the primary postoperative outcomes to evaluate in PGS.