Interarytenoid mucosal bridges complicating endotracheal intubation.

Glottic complications of endotracheal intubation have been well documented over many years; they include glottic stenosis and web formation. The author reports two cases of isolated mucosal bridges that formed as a result of short-term endotracheal intubation. Both patients complained of dysphonia and exercise intolerance, and both were found to have isolated interarytenoid mucosal bridges. The two patients were treated surgically, and both made a complete recovery and resumed normal premorbid function.

Patient 1 was a 69-year-old white woman who had been intubated and eventually tracheotomized for prolonged intubation following a cerebral hemorrhage. She had made a remarkable full neurologic recovery. However, during tracheal plugging exercises 9 months later, she manifested hoarseness and dyspnea. Endoscopic examination detected an interarytenoid vocal process bridge (figure 1). She was treated with sharp excision. She subsequently recovered her normal voice, and she was decannulated 1 week postoperatively.

[FIGURE 1 OMITTED]

Patient 2 was a 45-year-old Hispanic woman who had developed hoarseness and dyspnea on exertion following short-term intubation for abdominal surgery. She was found to have a thin mucosal bridge with only moderate restriction of vocal fold abduction (figure 2). Her symptoms resolved with simple excision of the web.

[FIGURE 2 OMITTED]

Complications of long-term endotracheal intubation were reported as early as 1968 by Harrison and Tonkin. (1) Because of the resting location of the tube and cuff, the posterior glottis is most often affected, and stenosis has been reported to occur in as many as 14% of patients who were intubated for more than 10 days. (2) Interarytenoid scarring without involvement of the interarytenoid region was described by Bogdasarian and Olson as a vocal process adhesion or a type I posterior glottic stenosis. (3) Such patients typically complain of hoarseness and stridor following intubation. On laryngoscopy, they are found to have normal anterior commissures and posterior larynges in addition to focal interarytenoid scarring. They respond well to simple excision without the need for stenting, and, assuming their vocal folds abduct normally, they do not experience recurrences.

References

(1.) Harrison GA, Tonkin JP. Prolonged (therapeutic) endotracheal intubation. Br J Anaesth 1968;40:241-9.

(2.) Whited RE. Posterior commissure stenosis post long-term intubation. Laryngoscope 1983;93:1314-18.

(3.) Bogdasarian RS, Olson NR. Posterior glottic laryngeal stenosis. Otolaryngol Head Neck Surg 1980;88:765-72.