Abstract
Introduction: Laryngeal stenosis is partial or circumferential narrowing of the endolaryngeal airway from congenital or acquired causes. It can present with life threatening upper airway obstruction, and the goal of treatment is restoration of good quality voice, respiration and laryngeal competence. We report a case of laryngeal stenosis following strangulation by a trapped overflowed head scarf, whilst being transported on a motor cycle and highlighted the treatment challenges. Methodology: A case of laryngeal stenosis studied, clinical findings, investigation results and treatment analysed. Results: A 70-year-old Nigerian elderly woman presented with three weeks’ history of hoarseness and progressive difficulty in breathing, following pulling of her long head scarf into the back wheel of the motor cycle taking her home. She had immediate loss of consciousness, which lasted for about 60 minutes. There was associated bout of cough while eating. Examination revealed life threatening upper airway obstruction. X-ray soft tissue neck showed soft tissue mass obliterating larygotracheal air column. Flexible nasopharyngolaryngoscopy showed grossly distorted laryngeal inlet with invisible vocal cords. CT scan of the larynx showed multiple and displaced fractures of the laryngeal cartilages. Microlaryngoscopy findings were pin-hole laryngeal lumen with firm collapsed mucosa. Emergency tracheostomy was done to relieve the upper airway obstruction. Attempts were made to excise the collapse mucosa and insert a stent proved difficult. Referral for endoscopic laser excision was caution because of the potential risk of aspiration. She was counselled and coping well with the tracheostomy.
Highlights
Laryngeal stenosis is partial or circumferential narrowing of the endolaryngeal airway from congenital or acquired causes
We report a case of laryngeal stenosis following strangulation by a trapped overflowed head scarf, whilst being transported on a motor cycle and highlighted the treatment challenges
Adult laryngeal stenosis can arise from the following causes: external laryngotracheal trauma from penetrating tissue injury, high or low velocity impact blunt force neck trauma, endolaryngeal trauma from endotracheal intubation, posttracheostomy, post-microlaryngeal resection and post radiotherapy [2] [3]
Summary
Laryngeal stenosis is a congenital or acquired narrowing of the airway that may affect the supraglottis, glottis and subglottis [1]. The subglottis is the most common site of involvement [1]. Chronic inflammatory diseases like sarcoidosis seldomly lead to laryngeal stenosis. Collagen vascular diseases such as wegener’s granulomatosis and relapsing polychondritis often result in laryngeal stenosis [4]. Treatment options are endoscopic or open surgical approaches. The choice of treatment option depends greatly on patient’s symptoms, site of involvement and degree of stenosis [5]. We present this case because of the treatment challenges encountered in her management
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