Subglottic synechia.

A 64-year-old woman presented to the otolaryngology clinic for evaluation after two different attempts at intubation prior to elective abdominal surgery had failed. The anesthesiology service reported that visualization of the glottis had been excellent on both occasions, but that the anesthesiologist was unable to pass an endotracheal tube of any size.

The patient's history was significant for a colectomy 5 months earlier. During that hospitalization, she experienced a difficult postoperative course, requiring three extubations and emergent reintubations. She was eventually extubated successfully, and she recovered without known sequelae. Her intubation difficulties notwithstanding, she denied any breathing difficulties, dyspnea on exertion, or change in vocal quality.

On videolaryngoscopic evaluation in our clinic, no lesions were immediately apparent, and vocal fold mobility was normal. However, on further examination of the subglottis, a scar band was seen spanning the airway from the right to the left (figure). No other lesions or masses were noted. The scar band prevented orotracheal intubation, but it did not compromise the airway enough to cause symptoms of dyspnea.

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The patient subsequently underwent direct microlaryngoscopy with jet ventilation and synechia excision with a C[O.sub.2] laser. She was then easily converted to general endotracheal intubation, and she was able to undergo abdominal surgery. She was extubated uneventfully.

Postoperatively, the patient did well and experienced no change in respiratory function or voice quality. Pathologic findings were consistent with a mature scar band. She continued to do well at the 3-month follow-up, at which she showed no evidence of recurrence or the development of subglottic stenosis.

From the Department of Otolaryngology--Head and Neck Surgery, Emory University School of Medicine, Atlanta.