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Introduction: Individuals with idiopathic subglottic stenosis (SGS) are at risk for voice disorders prior to and following surgical management. This study examined the nature and severity of voice disorders in patients with SGS before and after a revised cricotracheal resection (CTR) procedure designed to minimize adverse effects on voice function., Method: Eleven women with idiopathic SGS provided presurgical and postsurgical audio recordings. Voice Handicap Index (VHI) scores were also collected. Cepstral, signal-to-noise, periodicity, and fundamental frequency (F 0 ) analyses were undertaken for connected speech and sustained vowel samples. Listeners made auditory-perceptual ratings of overall quality and monotonicity., Results: Paired samples statistical analyses revealed that mean F 0 decreased from 215 Hz (standard deviation [SD] = 40 Hz) to 201 Hz (SD = 65 Hz) following surgery. In general, VHI scores decreased after surgery. Voice disorder severity based on the Cepstral Spectral Index of Dysphonia (KayPentax, Montvale, NJ) for sustained vowels decreased (improved) from 41 (SD = 41) to 25 (SD = 21) points; no change was observed for connected speech. Semitone SD (2.2 semitones) did not change from pre- to posttreatment. Auditory-perceptual ratings demonstrated similar results., Conclusion: These preliminary results indicate that this revised CTR procedure is promising in minimizing adverse voice effects while offering a longer-term surgical outcome for SGS. Further research is needed to determine causal factors for pretreatment voice disorders, as well as to optimize treatments in this population., Level of Evidence: 4. Laryngoscope, 127:2085-2092, 2017., (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)

The problem of rehabilitation of the patients presenting with post-intubation stenosis of the larynx and trachea remains unresolved despite the development of new methods for the diagnostics and treatment of this condition. One of the indications for long-term artificial lung ventilation is the severe form of Guillaine-Barret syndrome associated with paralysis of breathing muscles, development of bulbar symptoms, and disturbances of trophic process in the skin and mucous membranes. However, prolonged (mean 26 days) artificial lung ventilation may result in the formation of many-layer stenosis of the larynx and trachea whereas disturbed trophic processes in the skin and mucous membranes coupled to inadequate innervation complicate the postoperative conditions of the patients and promote restenosis of the tracheal lumen.

This study assesses the effect of pediatric laryngotracheoplasty on voice quality. A group of ten children who underwent laryngotracheoplasty with thyrotomy and anterior cartilage graft were examined two or more times after decannulation and their voices were compared to those of sex- and age-matched controls. Each examination included a laryngoscopy, evaluation by a speech/language pathologist and measurement of maximum phonation times and fundamental frequencies using the Signalyse program. The strength of the voices and the maximum phonation times gradually improved. The fundamental frequency became lower with age, as in the controls. The data suggest that laryngotracheoplasty does not hamper the development of voice with age in children and that the voice improves without any further surgery, although hoarseness remains.

Subglottic stenosis is defined as an obstructing lesion in the upper airway lying at a level between the base of the vocal cords superiorly and the lower border of the cricoid cartilage below. Symptoms of upper airway obstruction are characterized by inspiratory and expiratory stridor and dyspnea. Because most of these injuries follow translaryngeal intubation and assisted ventilation with or without tracheostomy, symptoms usually appear within a few weeks of extubation. This article reviews the management, techniques of reconstruction such as laryngofissure, stenting and endoscopic therapy, and the clinical experience (October 1973 through October 1995) gained with the operation of segmental subglottic resection and primary thyrotracheal anastomosis in 80 consecutive patients with benign disease.

When stenosis of the larynx and trachea involves loss to anterior support, this is usually corrected by an autograft of costochondral cartilage or of hyoid bone anchored with suture material. This paper describes an alternative technique employing a Vitallium alloy miniplate placed anterior to the airway as a means for providing support. This is placed over a fascial or auricular cartilage graft. Together, they provide a smooth scaffold for mucosal migration. Thirteen patients were treated at Indiana University Medical Center between 1991 and 1993 by means of this technique. Ten of the 13 patients (77%) achieved an adequate airway to allow decannulation. There have been no significant complications related to the use of the miniplate, and specifically, there have been no instances of infection or extrusion. It has been unnecessary to remove any of the miniplates. The Vitallium alloy miniplate offers unique advantages in laryngotracheal reconstruction in that it not only accurately approximates tissues, but it also provides external support to the airway.

Success in laryngotracheal reconstruction has been limited, in part, by the lack of an ideal grafting material. Perichondrium is thin, pliable, and highly vascularized and has the ability to generate new cartilage providing rigid support. These qualities make vascularized perichondrium potentially the ideal grafting material for circumferential airway stenosis. A pedicled vascularized flap of auricular perichondrium was used in a rabbit model (n = 39) to reconstruct a near-circumferential tracheal defect without a tracheostomy. A stent was used to support the reconstructed airway for 6 weeks, after which time it was removed by direct laryngoscopy. Animals were observed for an additional 6 weeks prior to sacrifice. Qualitative and quantitative histologic analysis of neochondrogenesis is reported. Vascularized perichondrium and periosteum show promise as potential grafts for reconstruction of circumferential tracheal defects.

Thorough knowledge of the laryngotracheal anatomy and physiology is a prerequisite for understanding the pathophysiology and for an adequate treatment of patients with anomalies, stenoses and other pathology in this area. The larynx is part of the upper respiratory tract, our voice organ and it prevents the passage of secretion and food to the lower airways. Anatomical differences between adults and children, males and females are important to consider, as the size of the structures underlies the decision for the size of tubes and cannulas to be used. Knowledge of the muscles and mucosa is important in augmentation, e.g. in phono-surgery and for procedures in patients with laryngeal palsy. The trachea with its location causes specific problems in the treatment of stenoses and tumours. The mucociliary system is nowadays being more focused upon.

Objective: To ascertain changes in laryngeal anatomy and function associated with poor voice outcome after laryngotracheal reconstruction (LTR) and to specifically describe dysphonia in pediatric patients treated for subglottic stenosis., Design: A survey was undertaken of patients having undergone LTR for subglottic stenosis. Twelve patients were recruited during the year 1990-1991. Nine patients were able to complete the endoscopic portion of the protocol that included fiberoptic and direct laryngoscopy. Speech samples were qualitatively evaluable in only six of nine patients (vocal quality, loudness, and intelligibility) and objectively in five of nine patients (fundamental frequency and pitch perturbation)., Patients: All patients in this consecutive sample had undergone LTR for congenital or acquired subglottic stenosis. The average age was 6 years. Each patient had previously undergone an average of two prior open laryngeal procedures and five endoscopic procedures., Outcome Measures: Correlation between anatomic and functional changes in the post-LTR larynx and voice outcome., Results: Endoscopic evaluation of the post-LTR larynx showed a 78% incidence of altered anatomy and 44% incidence of altered function. Speech sample analysis showed the following: 100% decreased vocal quality, 50% decreased intelligibility, 100% decreased volume, and 80% low fundamental frequency and increased jitter., Conclusions: Children with high-grade subglottic stenosis and multiple prior surgeries are at high risk for poor voice outcome after LTR. Future prospective studies will allow substantiation of this observation and clarification of which changes in laryngeal structure and function arise from surgery per se.