Clinical Snapshot
Emphysema Following Dissection of the Glottic Synechia in Concealed Anterior Laryngeal Cleft
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A 65-year old female patient who was aphonic following an intubation injury but previously had normal voice function exhibited glottic stenosis due to scarring and anterior vocal fold synechia on videolaryngostroboscopy. During a transoral microlaryngoscopy procedure involving CO2 laser-assisted glottic enlargement for surgical voice improvement, the synechia had been medially transected and the vocal folds bilaterally detached from the thyroid cartilage at the front. Postoperatively, extensive cervicofacial and mediastinal soft tissue emphysema developed. This can be seen in the computer tomography with morphologically visible dehiscence of the thyroid cartilage at the front. During transcervical exploration, an anterior vertical laryngeal cleft was found (right Figure). This was not caused by laser use. The soft tissue between the thyroid cartilage laminae ruptured during speech and coughing, leading to the development of emphysema. The edges of the cleft were adapted with non-absorbable suture material and the overlying tissue was closed in multiple layers. Thereupon, the emphysema resolved. Laryngeal clefts are usually rare malformations of the posterior laryngeal wall (incidence 0.5–1:10 000). This is—to the best of our knowledge—the first description of a continuous anterior laryngeal cleft in adulthood, which only became symptomatic as a result of endolaryngeal laser surgery to achieve glottic enlargement and was discovered during surgical revision. An acquired, differentially diagnosed (post)operative or traumatic etiology was excluded.
Prof. Dr. med. Philipp P. Caffier, Prof. Dr. med. Dirk Mürbe, Prof. Dr. med. Tadeus Nawka, Klinik für Audiologie und Phoniatrie, Charité – Universitätsmedizin Berlin, philipp.caffier@charite.de
Conflict of interest statement: The authors state that no conflict of interest exists.
Translated from the original German by Christine Rye.
Cite this as: Caffier PP, Mürbe D, Nawka T: Emphysema following dissection of the glottic synechia in concealed anterior laryngeal cleft.
Dtsch Arztebl Int 2024; 121: 695. DOI: 10.3238/arztebl.m2024.0076
