Endoscopic Carbon Dioxide Laser Arytenoidectomy for Postintubation Glottic Obstruction

Abstract

At the annual meeting of the American Academy of Otolaryngology—Head and Neck Surgery, San Diego, Calif, September 1990, Romeo Y. Lim, MD, Charleston, WVa, recently reported his experience utilizing endoscopic carbon dioxide laser arytenoidectomy for postintubation glottic obstruction. He described how 10 patients were treated who had developed fixation of an arytenoid after prolonged intubation for respiratory insufficiency. All of the patients had been unable to be decannulated after tracheostomy. His technique involved using the carbon dioxide laser set at 15 W and pulses of 0.2 to 0.5 seconds to first incise the mucosa over the arytenoid. The arytenoid, vocal process, and posterior vocal cord were then resected, being careful not to injure the interarytenoid space. Following surgery, all patients were successfully decannulated within 3 to 14 days and their voices returned. After adequate time for healing, laryngeal examination revealed posterior glottic chink sizes of 4 to 5 mm and