Posterior Glottic Fixation in Children

Abstract

Vocal cord fixation from posterior glottic stenosis may produce progressive airway obstruction. Treatment involves scar excision with adjunctive procedures on healthy tissue, including arytenoidopexy, arytenoidectomy, cordectomy, and cordotomy. Twenty-five children with posterior glottic stenosis were studied; 6 had vocal cord fixation in the midline and 6 had limited vocal cord abduction. All were tracheotomy-dependent because of posterior glottic stenosis and secondary impairment of vocal cord mobility. All children were decannulated after scar incision and widening of the laryngeal framework with posterior cricoid split and stenting. Cartilage grafting was used in 11 patients to maintain an adequate glottic lumen. Ten regained full vocal cord mobility. One had limited adduction, while another's cords were refixed in the midline. A second procedure in the latter patient resulted in limited abduction. Aspiration did not occur in any of the patients, and the voice results were good. Scar incision with cricoid split, cartilage grafting, and stenting is an excellent method for treating posterior glottic fixation without destroying healthy tissue.