Outcomes in Awake Laser Laryngeal Stenosis Surgery (ALLSS): A 5-Year Retrospective Review

Abstract

Objectives: In patients with significant upper airway stenosis, airway compromise can occur associated with general anesthesia (GA). A previous study demonstrated the feasibility of awake laser laryngeal stenosis surgery (ALLSS) in the operating room (OR) in five patients. This study sought to determine patient outcomes of ALLSS. Methods: Retrospective chart review identified 32 surgical cases (11 bilateral, 21 unilateral) among 16 patients over a 5-year period. At least unilateral transverse cordotomy, or CO2 laser excision of glottic and/or supraglottic stenosis, was performed. Patient demographics, complications, outcomes, and pre- and post-procedure voice handicap index-10 (VHI-10), eating assessment tool-10 (EAT-10) and dyspnea index (DI) were analyzed. Results: Of 16 patients (mean age = 65.6, 68.8% male), postoperative DI was significantly lower than preoperative DI (p = 0.001) with no significant difference in pre- and postoperative VHI-10 (p = 0.132) or EAT-10 (p = 0.316). Two surgical events required general anesthesia conversion. Two patients were tracheostomy dependent preoperatively with one successfully decannulated postoperatively. Three of the remaining 14 patients (21%) ultimately required tracheostomy due to aspiration pneumonia (n = 1) and fixed airway obstruction (n = 2). Of 32 surgeries, three major (airway edema requiring hospitalization, intubation due to respiratory failure, urgent tracheostomy) and three minor (three post-operative granulomas, two of which required surgical intervention) complications occurred. No bleeding difficulties were encountered associated with ALLSS. Conclusions: ALLSS can provide meaningful improvement for the treatment of glottic/supraglottic stenosis and may provide an effective alternative to stenosis surgery done under general anesthesia. At present, ALLSS should be performed in the OR with an experienced anesthesia team. Level of Evidence: 4.