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Endoscopic treatment of anterior glottic webs according to Lichtenberger technique and results on 18 patients

  • Laryngology
  • Published:
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Abstract

Anterior glottic webs are most frequently acquired and result in a major vocal handicap. Many treatment modalities have been reported in the literature. None of them achieves perfect morphological or functional results. We present our series treated by an endoscopic technique based on CO2 laser section of the web, mitomycin application and placement of a temporary silastic stent. We retrospectively reviewed the charts of 18 consecutive patients with anterior webs treated at our university hospital between 2003 and 2010. The endoscopic technique consisted of the section of the web with the CO2 Acublade system, immediate application of mitomycin C and placement of a silastic stent. No tracheostomy was required. The stent was removed 3 weeks later. Patients had a vocal evaluation pre and postoperatively. It consisted of a video-stroboscopic examination, the global score of the Voice Handicap Index, the global and roughness scores of the perceptive voice evaluation according to Hirano, acoustic and aerodynamic parameters. Eighteen patients were included in the study with a mean age of 46 years (min. = 5, max. = 76). Twenty-two percent were women. All patients had postoperative speech therapy. The mean follow-up is 48.4 months (3–87 months). At the last follow-up, none of the patients had recurrence of the laryngeal web. The grade G of dysphonia significantly decreased from 2 to 1 (p = 0.035). CO2 laser resection of anterior webs with mitomycin C application and placement of a silastic stent for 3 weeks induces a good morphological result with absence of web reformation but without substantial voice improvement observed in our series.

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References

  1. Izadi F, Delarestaghi MM, Memari F, Mohseni R, Pousti B, Mir P (2010) The butterfly procedure: a new technique and review of the literature for treating anterior laryngeal webs. J Voice 24:742–749

    Article  PubMed  Google Scholar 

  2. Liyanage SH, Khemani S, Lloyd S, Farrell R (2006) Simple keel fixation technique for endoscopic repair of anterior glottic stenosis. J Laryngol Otol 120:322–324

    PubMed  CAS  Google Scholar 

  3. De Monès E, Lagarde F, Hans S, Ménard M, Laccourreye O, Brasnu D (2004) Mitomycin C: prevention and treatment of anterior glottic synechia. Ann Otolaryngol Chir Cervicofac 121:229–234

    Article  PubMed  Google Scholar 

  4. Dedo HH, Sooy CD (1984) Endoscopic laser repair of anterior glottic, subglottic and tracheal stenosis by division of micro trapdoor flap. Laryngoscope 94:445–450

    Article  PubMed  CAS  Google Scholar 

  5. Isshiki N, Taira T, Nose K, Kojima H (1991) Surgical treatment of laryngeal web with mucosa graft. Ann Otol Rhinol Laryngol 100:95–100

    PubMed  CAS  Google Scholar 

  6. Schweinfurth J (2002) Single-stage, stentless endoscopic repair of the anterior glottic webs. Laryngoscope 112:933–935

    Article  PubMed  Google Scholar 

  7. Lichtenberger G, Toohill RJ (1994) New keel fixing technique for endoscopic repair of anterior commissure webs. Laryngoscope 104:771–774

    Article  PubMed  CAS  Google Scholar 

  8. Remacle M, Lawson G, Nolleveaux MC et al (2008) Current state of scanning manipulator applications with the carbon dioxide laser. Ann Otol Rhinol Laryngol 117:239–244

    PubMed  Google Scholar 

  9. Macnaught RC (1950) Surgical correction of the anterior web of the larynx. Laryngoscope 60:264–272

    Google Scholar 

  10. Montgomery WW, Gamble JE (1970) Anterior glottic stenosis. Experimental and clinical management. Arch Otolaryngol 92:560–567

    Article  PubMed  CAS  Google Scholar 

  11. Holinger LD, Wong HW, Hemenway WG (1975) Simultaneous glottic and supraglottic laryngeal webs. Arch Otolaryngol 101:496–497

    Article  PubMed  CAS  Google Scholar 

  12. Jackson C, Coates G (1930) The nose, throat, and ear and their diseases, 1st edn. WB Saunders, Philadelphia

    Google Scholar 

  13. Stasney CR (1995) Laryngeal web: a new treatment for an old problem. J Voice 9:106–109

    Article  PubMed  CAS  Google Scholar 

  14. Haslinger F (1924) A case of membrane formation in larynx, a new method of safer recovery (in German). Monatsschr Ohrenheilkd Laryngorhinol 22:174–176

    Google Scholar 

  15. Dedo HH (1979) Endoscopic teflon keel for anterior glottic web. Ann Otol Rhinol Laryngol 88:467–473

    PubMed  CAS  Google Scholar 

  16. Parker DA, Das Gupta AR (1987) An endoscopic silastic keel for anterior glottis webs. J Laryngol Otol 101:1055–1061

    Article  PubMed  CAS  Google Scholar 

  17. Casiano RR, Lundy DS (1998) Outpatient transoral laser vaporization of anterior glottic webs and keel placement: risks of airway compromise. J Voice 12:536–539

    Article  PubMed  CAS  Google Scholar 

  18. Sataloff RT, Hawkshaw M (1998) Endoscopic internal stent: a new procedure for laryngeal webs in the presence of papilloma. Ear Nose Throat J 77:949–950

    PubMed  CAS  Google Scholar 

  19. Hsueh J-Y, Stella Tsai C-S, Hsu H-T (2000) Intralaryngeal approach to laryngeal web using lateralization with silastic. Laryngoscope 110:1780–1782

    Article  PubMed  CAS  Google Scholar 

  20. Edwards J, Tanna N, Bielamowicz SA (2007) Endoscopic lysis of anterior glottis webs and silicone keel placement. Ann Otol Rhinol Laryngol 116:211–216

    PubMed  Google Scholar 

  21. Wang Z, Pankratov MM, Rebeiz EE, Perrault DFJR, Shapshay SM (1995) Endoscopic diode laser welding of mucosal grafts on the larynx: a new technique. Laryngoscope 105:49–52

    Article  PubMed  CAS  Google Scholar 

  22. Rosen CA, Simpson CB (2008) Anterior glottis web. In: Operative techniques in laryngology, Chap. 26, Springer, Berlin, pp 159–164

  23. Hsiung M-W, Wang H-W (2002) Endoscopic buccal mucosal grafting to the anterior glottic web: a case report. Eur Arch Otorhinolaryngol 259:287–289

    Article  PubMed  Google Scholar 

  24. Singh G, Wilson MR, Foster CS (1988) Mitomycin eye drops as treatment for pterygium. Ophthalmology 95:813–821

    PubMed  CAS  Google Scholar 

  25. Chen CW, Huang HT, Blair JS, Lee CC (1990) Trabeculectomy with simultaneous topical application of mitomycin C in refractory glaucoma. J Ocul Pharmacol 6:175–182

    Article  PubMed  Google Scholar 

  26. Chung JH, Cosenza MJ, Rahbar R, Metson RB (2002) Mitomycin C for the prevention of adhesion formation after endoscopic sinus surgery: a randomized, controlled study. Otolaryngol Head Neck Surg 126:468–474

    Article  PubMed  Google Scholar 

  27. Holland BW, Mcguirt WF (2001) Surgical management of choanal atresia: improvement outcome using mitomycin. Arch Otolaryngol Head Neck Surg 127:1375–1380

    PubMed  CAS  Google Scholar 

  28. Hartnick CJ, Hartley BE, Lacy PD et al (2001) Topical mitomycin application after laryngotracheal reconstruction. Arch Otolaryngol Head Neck Surg 127:1260–1264

    PubMed  CAS  Google Scholar 

  29. Rahbar R, Jones DT, Roberson DW, Kenna MA, Mcgill TJ, Healy GB (2002) The role of mitomycin in the prevention and treatment of scar formation in the pediatric aerodigestive tract. Arch Otolaryngol Head Neck Surg 128:401–406

    PubMed  Google Scholar 

  30. Rahbar R, Shapshy SM, Healy GB (2001) Mitomycin: effects on laryngeal and tracheal stenosis, benefits, and complications. Ann Otol Rhinol Laryngol 10:1–6

    Google Scholar 

  31. Bindlish R, Condon GP, Schlosser JD, D’antonio J, Lauer KB, Lehrer R (2002) Efficacy and safety of mitomycin-C in primary trabeculectomy: five-year follow-up. Ophthalmology 109:1336–1341

    Article  PubMed  Google Scholar 

  32. Debry PW, Perkins TW, Heatley G, Kaufman P, Brumback LC (2002) Incidence of late-onset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol 120:297–300

    Article  PubMed  CAS  Google Scholar 

  33. Hu D, Sires BS, Tong DC et al (2000) Effect of brief exposure to mitomycin C on cultured human nasal mucosa fibroblasts. Ophthal Plast Reconstr Surg 16:119–125

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors did not receive any financial support for the writing of this article.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Otolaryngology, Head and Neck Surgery Department, Louvain University Hospital of Mont-Godinne, Dr Therasse Avenue, No. 1, 5530, Yvoir, Belgium

    N. Benmansour, M. Remacle, G. Lawson, V. Bachy & S. Van Der Vorst

  2. Otolaryngology, Head and Neck Surgery Department, Hôtel Dieu de France, Bellevue Medical Center, Saint-Joseph University, Beirut, Lebanon

    N. Matar

Authors
  1. N. Benmansour
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  2. M. Remacle
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  3. N. Matar
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  4. G. Lawson
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  5. V. Bachy
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  6. S. Van Der Vorst
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Corresponding author

Correspondence to M. Remacle.

Additional information

The manuscript was accepted as an oral presentation at the French Society of Otolaryngology Head and Neck Surgery, October 2011, Paris, France.

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Benmansour, N., Remacle, M., Matar, N. et al. Endoscopic treatment of anterior glottic webs according to Lichtenberger technique and results on 18 patients. Eur Arch Otorhinolaryngol 269, 2075–2080 (2012). https://doi.org/10.1007/s00405-012-2001-z

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  • DOI: https://doi.org/10.1007/s00405-012-2001-z

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