Subglottic bridge stenosis (SgBS) after long-term intubation, followed by tracheostomy, which separates the subglottic lumen into an anterior and posterior channels presents a rarity. If not diagnosed it could lead to impairment of the breathing and can be mistaken for bilateral vocal fold paralysis.
MATERIAL AND METHODS: A prospective study of the value of transstomal endoscopy with angulated endoscopes to detect subglottic lesions in patients, subjected to tracheostomy after being intubated through the larynx as a routine examination before decannulation. Rigid angulated endoscopes of the Hopkins type with 70o and 90o degrees were used for retrograde transstomal laryngoscopy.
RESULTS: Examined were 23 consecutive patients (17 male, 6 female, aged 55,4 ±14 years), which had initially transoral intubation for assisted mechanical ventilation, which later was changed to tracheostomy. In 19/23 (82,6%) of the patients the endoscopic examinations revealed no pathology. In 3/23 (13,4%) transoral laryngoscopy showed immobile vocal folds. The supplementary retrograde transstomal laryngoscopy allowed to differentiate between SgBS (two cases; 8,7%) and vocal fold paralysis (one case; 4,3%). The two cases with SgBS were success fully treated using an endoscopic microlaryngeal technique.
CONCLUSION: SgBS are hard to be noticed with standard transoral/transnasal laryngeal endoscopy. The clinical constellation of long-term transoral intubation, followed by tracheostomy seems to be predisposing for the formation of SgBS. The retrograde transstomal laryngocopy is a low resource consuming method, which can be used even in un conscious patients, which do not cooperate for the examination. It allows for optimal examination of the subglottis, the stoma and the trachea before decannulation.
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