Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
Laryngoscope. 2019 Oct;129(10):2239-2243. doi: 10.1002/lary.27524. Epub 2019 Feb 18.
Posterior glottic stenosis (PGS) often requires a destructive surgical treatment. Early PGS treatment involves glottic dilation to reduce airway constriction associated with chronic PGS. Round laryngeal dilation may not optimize posterior glottic dilation due to the teardrop shape of the glottis and may injure vocal fold tissue. We compared pressure applied to the glottis during traditional single balloon dilation and a novel, anatomically appropriate dilation technique (teardrop-shaped glottic dilation [TSGD]).
Pressure sensors were affixed at various points on a three-dimensional printed glottic model. The anterior glottis was stented with a triangular stent (18-32F) in combination with balloon dilator (10-20 mm) placed in the posterior glottis (TSGD) in 30 unique combinations. Force applied to the vocal folds (VF) and posterior commissure (PC) during round balloon dilation and TSGD was measured.
Dilatory force in the PC ranged from 0.0-3.8 newtons (N) using balloon dilators and 0.0-17.5 N using TSGD. The TSGD technique yielded a superior ratio of force applied to the PC versus VF (P = 0.0296) compared to round balloon dilation alone. Optimal targeting of the PC occurred when the sum of the anteroposterior (AP) dimensions of the stent and balloon dilator approached the AP length of the glottis.
Use of an anatomically appropriate glottic dilation maximizes expansive force applied to the posterior commissure and decreased force to the vocal folds. This study demonstrates that TSGD minimizes force to the anterior glottis and maximizes dilation of the posterior glottis. This technique may play a role in preventing laryngeal stenosis associated with chronic PGS.
NA Laryngoscope, 129:2239-2243, 2019.
后声门狭窄（PGS）常需破坏性手术治疗。早期 PGS 治疗涉及声门扩张以减少与慢性 PGS 相关的气道狭窄。由于声门呈泪滴状，圆形喉扩张可能无法优化后声门扩张，并且可能损伤声带组织。我们比较了传统单球囊扩张和新型解剖学适当扩张技术（泪滴状声门扩张[TSGD]）期间施加在声门上的压力。
在三维打印的声门模型的各个点上贴附压力传感器。在前声门上用三角形支架（18-32F）结合放置在后声门（TSGD）中的球囊扩张器（10-20mm）支撑声门，共进行了 30 种独特组合。测量了在圆形球囊扩张和 TSGD 期间施加在声带（VF）和后联合（PC）上的力。
使用球囊扩张器时，PC 的扩张力范围为 0.0-3.8 牛顿（N），使用 TSGD 时为 0.0-17.5 N。与单独使用圆形球囊扩张相比，TSGD 技术使施加在 PC 上的力与 VF 的比值更优（P=0.0296）。当支架和球囊扩张器的前后（AP）尺寸之和接近声门的 AP 长度时，PC 的最佳靶向发生。
使用解剖学上适当的声门扩张最大限度地增加了施加在后联合上的扩张力，并减少了对声带的力。本研究表明，TSGD 最大限度地减少了对前声门的力，并最大限度地扩张了后声门。该技术可能在预防与慢性 PGS 相关的喉狭窄方面发挥作用。
无喉镜，129：2239-2243，2019。
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