Truly false vocal folds: an unusual complication of chemoradiation therapy.

A 63-year-old woman presented with a history of increasing inspiratory stridor and shortness of breath of several months' duration. One year previously she had been diagnosed with a supraglottic squamous cell carcinoma and treated with concurrent chemotherapy and radiation therapy. She had been treated recently with albuterol and steroid inhalers for adult-onset asthma and COPD without improvement in symptoms. She was unable to walk more than 50 to 100 feet without stopping to rest.

Examination in the office revealed inspiratory stridor at rest, a prolonged expiratory phase, and a mildly hoarse voice. The patient had a fixed extrathoracic obstruction on previsit pulmonary function testing. On flexible laryngoscopy, the patient was noted to have a circumferential supra glottic stenosis with a 3-mm x 1-mm airway. Vocal folds could be glimpsed beneath the stenosis. There appeared to be secondary posterior glottic stenosis, but cricoarytenoid motion could not be adequately assessed.

The patient was brought to the operating room, and an awake tracheostomy was performed because the tight stenosis precluded oral intubation. Initial examination of the larynx showed what appeared to be normal vocal folds with obvious radiation change (figure 1). It was only after the scarred false vocal folds were retracted to the left (figure 2, A) and right (figure 2, B) that the real true vocal folds were revealed. A C[O.sup.2] laser was used to resect the false vocal folds bilaterally. An inferiorly based mucosal flap was preserved on the right side and sutured over the raw area. Final surgical appearance after this stage is shown in figure 3. The posterior glottic stenosis was addressed with a second procedure after complete healing of the supraglottis with excellent postoperative airway and relief of dyspnea symptoms.

[FIGURE 1-2 OMITTED]

Timothy D. Anderson, MD

From the Department of Otolaryngology-Head and Neck Surgery, Lahey Clinic, Burlington, Mass.