Supraglottic stenosis: etiology and treatment of a rare condition.

OBJECTIVES: Although laryngotracheal stenosis is well described in the literature, the vast majority of cases are of stenosis at either the subglottic or glottic level. Supraglottic stenosis is an unusual subset of laryngotracheal stenosis that has distinctly different causes, symptoms, and treatment options.

METHODS: A retrospective chart review was conducted on all adult patients at our institution with a diagnosis of supraglottic stenosis. Clinical records, videolaryngoscopic examinations, and operative and clinic procedure records were reviewed. All patients had a minimum follow-up of 12 months.

RESULTS: Eight patients with supraglottic stenosis were identified. Five (62.5%) had a history of radiation therapy, and the remaining 3 cases were associated with autoimmune disorders. Our data revealed a frequent association with dysphagia (7 of 8 cases, or 87.5%), including 2 patients with complete pharyngoesophageal stricture and 3 who required a percutaneous gastrostomy tube. All of the patients required more than 1 surgical intervention because of symptomatic recurrent airway stenosis. Three patients underwent successful endoscopic treatment with a carbon dioxide laser in the operating room. One of these patients and 5 additional patients were successfully managed with pulsed KTP laser treatment in the clinic setting without complications. We observed 2 cases of acute intraoperative supraglottic edema in the setting of suspension laryngoscopy and jet ventilation, 1 of which necessitated emergent tracheostomy.

CONCLUSIONS: Supraglottic stenosis is a rare condition that is often associated with external-beam radiation or autoimmune disorders. All of the patients in our series experienced some degree of symptomatic airway obstruction that required management. The majority also had coexisting dysphagia, often associated with pharyngeal or esophageal stricture. Despite the favorable response to endoscopic treatment, all patients eventually required additional procedures because of symptomatic recurrence of their stenosis. Although endoscopic surgical treatment with a carbon dioxide laser in the operating room setting is a viable option, office-based treatment with a pulsed KTP laser appears to be an effective and potentially safer alternative.