Shoffel-Havakuk Hagit, Lahav Yonatan, Shopen Yoni, Reuven Yonatan, Bachar Gideon, Hamzany Yaniv
Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Petah Tikva, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Laryngoscope. 2023 Apr;133(4):883-889. doi: 10.1002/lary.30293. Epub 2022 Jul 11.
To describe the DISCO protocol (Dilation, Steroid injection, and post-operative Cough Exercise); a novel treatment for posterior glottic stenosis (PGS). Restoring glottic mobility in PGS is a major challenge. In orthopedic and plastic surgery, post-operative physical therapy is associated with improved motion range and flexibility; yet, this principle was never applied to laryngeal surgery.
A retrospective cohort of PGS adult patients, treated by the DISCO protocol during 2018-2020. DISCO involves the following: scar release, glottic dilation, and steroid injection, followed by post-operative cough as glottic physical therapy. Maximal glottic opening angle (MGOA), relative glottic opening area (RGOA), and relative glottic insufficiency area (RGIA) were calculated before and post-operatively.
Seventeen patients were included; PGS etiology was post-intubation (n = 10), post-irradiation (n = 3), both (n = 1) and joint sclerosis (n = 3). Six patients also had additional airway disorders. Sixteen patients were tracheostomy-dependent. 2 (12%), 8 (47%) and 7 (41%) patients had type II, III and IV stenosis, respectively. Surgery included scar release, dilation and steroid injection alone in 7 patients; and additional unilateral sub-mucosal arytenoidectomy in 10. The mean follow-up was 17.5 months. There were no major complications. Successful outcomes (e.g., decannulation or permanent capping) were achieved in 14 (82%) patients with some restoration of joint movement. None had a persistent voice or swallowing complaints. Both MGOA and RGOA increased in all patients (p < 0.001). RGIA remained unchanged (p = 0.878).
The DISCO protocol is a novel, effective and safe approach for PGS correction that can be easily applied. It can restore vocal fold mobility and may expand the glottic airway without causing glottic insufficiency.
4 Laryngoscope, 133:883-889, 2023.
描述DISCO方案（扩张、类固醇注射及术后咳嗽锻炼）；一种治疗后声门狭窄（PGS）的新方法。恢复PGS患者的声门活动度是一项重大挑战。在整形外科手术中，术后物理治疗与改善活动范围和灵活性相关；然而，这一原则从未应用于喉部手术。
对2018年至2020年期间采用DISCO方案治疗的PGS成年患者进行回顾性队列研究。DISCO方案包括以下内容：瘢痕松解、声门扩张、类固醇注射，随后进行术后咳嗽作为声门物理治疗。术前和术后计算最大声门开口角度（MGOA）、相对声门开口面积（RGOA）和相对声门关闭不全面积（RGIA）。
纳入17例患者；PGS病因包括插管后（n = 10）、放疗后（n = 3）、两者皆有（n = 1）和关节硬化（n = 3）。6例患者还患有其他气道疾病。16例患者依赖气管切开。2例（12%）、8例（47%）和7例（41%）患者分别患有II型、III型和IV型狭窄。7例患者的手术包括单纯瘢痕松解、扩张和类固醇注射；10例患者还进行了额外的单侧黏膜下杓状软骨切除术。平均随访时间为17.5个月。无重大并发症。14例（82%）患者获得成功结果（如拔管或永久封堵），声门关节活动有一定恢复。无一例患者有持续的声音或吞咽问题。所有患者的MGOA和RGOA均增加（p < 0.001）。RGIA保持不变（p = 0.878）。
DISCO方案是一种新颖、有效且安全的PGS矫正方法，易于应用。它可以恢复声带活动度，并可能扩大声门气道而不导致声门关闭不全。
4 喉镜，133:883 - 889，2023年。
