Comparative Study between Laryngotracheal Reconstruction with Partial and Complete Laryngofissure for Management of High Grade Glottic Web

Abstract

Background: Laryngeal (glottic) webs are associated with airway stenosis at the level of the glottis. Surgical intervention is the gold standard. Laryngotracheal reconstruction (LTR) is the standard technique with partial or complete laryngofissure. The choice between partial and complete laryngofissure remains debated. Thus, this study aimed to compare the efficacy of LTR with partial or complete laryngofissure for management of thick glottic web.

Patients and Methods: This study included 20 patients. All patients were clinically evaluated by full history (from the patient and his/her guardians), clinical examination, laboratory investigations and endoscopic laryngeal examination. Then submitted to surgical intervention in the form of LTR with partial or complete laryngofissure (each 10 subjects). Patients were referred to Phoniatric Outpatient Clinic to perform pre- and post-operative phoniatric assessment.

Results: Patients in both groups were comparable regarding their demographics, preoperative clinical and voice assessment. Operative time was significantly longer in complete than partial groups (166.5±11.07 vs 117.5±8.9 minutes).  Postoperative voice data showed that LTR with complete laryngofissure was significantly associated with lower fundamental frequency and jitter when compared to partial group (260.69±26.98, 1.61±1 vs 309.6±48.9, 2.61±1, successively). Time to decannulation was significantly longer in LTR with complete than partial laryngofissure. Rewebbing was registered for 3 cases in partial groups (2 grade-1 and 1 grade-2), while laryngeal collapse was reported in 1 patient in complete group.  Improvement of breathing was reported for all patients in both groups. In addition, voice was improved in all patients in complete, but only in 70% of partial groups. Overall surgical success was registered for all compared to 70% of partial groups.  

Conclusion: Complete LTR offers superior functional results, particularly for achieving stable, high-quality voice, and can be considered the preferred approach when maximal structural and phonatory restoration was desired.