Cricoarytenoid joint mobilization with mucosal flap reconstruction for posterior glottic stenosis

Abstract

Posterior glottic stenosis (PGS) is usually caused by long-term intubation and can be very challenging to manage in particular if both cricoarytenoid joints (CAJ) are involved. Most surgical approaches are limited to enlarging the airway by resecting portions of the posterior commissure and glottis compromising on both, voice and respiratory function. In the following, we describe an endoscopic technique that can restore arytenoid mobility in a selected group of patients suffering from high-grade PGS. Patients must have intact CAJ facets and a normal joint space that is not replaced by fibrosis or bone to benefit from this procedure. When performing this procedure, the fibrotic tissue between the arytenoids and around both CAJ is ablated and both arytenoids are mobilized by performing CAJ capsulotomies to restore arytenoid mobility. A mucosal rotational advancement flap, raised from the postcricoid and medial pyriform sinus, is used to reconstruct the interarytenoid space and the posterior commissure.