Supraglottic Stenosis
Supraglottic stenosis is a pathologic narrowing of the airway above the level of the true vocal folds, involving the epiglottis, aryepiglottic folds, false vocal cords, or adjacent pharynx and epiglottis.
Common Etiologies Include:
- Radiation therapy (most frequent acquired cause in adults)
- Prolonged intubation
- Scarring after trauma, such as a gunshot wound
- Infection or inflammatory disorders (e.g., Wegener’s granulomatosis (granulomatosis with polyangiitis))
- Postsurgical or post-laser changes
Clinically, Supraglottic Stenosis may Cause:
- Airway restriction (noisy breathing, shortness of breath especially with exertion)
- Voice change (due to altered supraglottic resonance, often a “tinny” or muffled quality)
- Swallowing difficulty (dysphagia from impaired epiglottic inversion, reduced upward mobility of the larynx, etc.)
Diagnosis
Diagnosis is confirmed best by laryngoscopic visualization, often using flexible endoscopy and secondarily via x-ray imaging.
Photo Essay
This patient previously underwent definitive chemo- and radiotherapy for base-of-tongue carcinoma. He describes a rugged treatment course marked by a profoundly sore throat that persisted for several months. Since completion of therapy, he has experienced a permanent change in voice quality, noticeable but manageable dysphagia, and a restricted airway (somewhat “heavy breathing”) that does not bother his sleep and which he does not allow to limit his active lifestyle.
Although he had numerous cancer-surveillance visits at other centers, he appeared unaware of his supraglottic stenosis, which is likely stable and long-standing, given the chronic alterations in voice, swallowing, and airway that date back to the time of treatment.
He is scheduled for CO₂ laser release of epiglottis-to-pharynx tethering, intended to partially reduce the supraglottic stenosis. He understands that while this procedure may improve his airway symptoms, it is unlikely to restore normal anatomy or completely resolve the synechia tethering the epiglottis to the pharyngeal wall.
Supraglottic Stenosis (1 of 4)
Epiglottic Tip (2 of 4)
Closer View (3 of 4)
Normal Hypopharynx (4 of 4)
Example 2
This man was treated with radiotherapy for vocal cord cancer 35 years prior to this examination. Ever since that time, breathing has been slightly noisy, and he does have a sense of mild airway restriction but only with exercise. He sleeps well and has never had any frightening episodes during upper respiratory infections.
Still when he does get a URI, he is aware of increase effort to cough out mucus. This is presumably because the “hood” over the posterior glottis catches mucus on its undersurface. He presented for an explanation, and also out of curiosity due to some recent comments by people new to him, about his mild breathing noises.
Supraglottic stenosis (1 of 3(
Closer view (2 of 3)
Scar band (3 of 3)
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