Improvized laryngeal cautery forcep in microsurgical treatment of laryngotracheal stenosis - experience in Nigeria, Subsaharan Africa

Abstract

Traumatic laryngotracheal stenosis is uncommon, however it seems to be increasing due to improvement in survival after trauma and detection of injury. Surgical options include dilatation and intralesional steroid, endolaryngeal microsurgery and laryngotracheal resection and anastomosis. We report our experience with management of traumatic laryngotrachea l stenosis using improvised cauterization forcep in endolaryngeal microsurgery, in the absence of supportive facility for open laryngeal surgery in resource - poor sub-Saharan Africa. This is a retrospective analysis of the outcome of endolaryngeal microsurgery in patient with laryngotracheal stenosis using our improvised laryngeal cautery forceps. Traumatic A Iindholm laryngoscope suspended by a Riecher-Kleinsasser laryngoscope holder and chest support; and Carl Zeiss operating microscope (Op MI 1) was used for surgery. We improvised a laryngeal cauterization forcep by using an oesophageal foreign body forcep inserted in the measured length of fluid-giving set. exposing about 1cm of the cutting end would insulate the forcep against the laryngotracheal wall. The diathermy handle is applied to the exposed end of the forceps. All the patients had endolaryngeal microsurgery and intralesional steroid. Thirteen endolaryngeal microsurgical procedures were done on 5 patients, 4 males and 1 female. The age ranged between 19 and 62 years. Functional voice and decannulation was achieved in 2/5 patients after each had had between 2 - 3 procedures. The indications in all was hoarseness while there was in addition, upper airway obstruction and dependence on tracheostomy in 3. The stenosis was supraglottic in. 2, combined glottic and subglottic in 1 and laryngotracheal involvement in 2. Using the circumference of the laryngeal lumen as reference for severity of stenosis, 2 patients had a 50-70% lumen obstruction while 2 had a 71-99% and 1 had 100% lumen obstruction. We found the improvisation of the laryngeal cautery forcep useful for procedures in the larynx and recommend it to resource - poor centres where appropriate facilities are yet available. However, this further shows that the role of endolaryngeal microsurgery is limited in laryngotracheal stenosis. The availability of other therapeutic modalities and training of personnel will give us the opportunity of a randomized treatment comparison in future.