Subglottic and glottic stenosis — narrowing of the airway at or just below the vocal cords — can result from prolonged intubation, trauma, prior surgery, inflammatory conditions, or idiopathic causes. When the narrowing is significant enough to compromise breathing or voice, treatment is directed at reopening the airway.
Dividing the scar, not removing it
Excision of a subglottic scar carries a high rate of recurrence. I don’t cut scar out. What I do instead, in one sitting:
Stellate incisions. The scar is divided in a star pattern while a good deal of the mucosa is left intact. The aim is to release the constricting ring, not to resurface the airway.
Balloon dilation. The divided segment is then stretched to restore diameter. Of the three components this gives the most initial improvement — but the incisions add to what a balloon alone achieves, so the two belong together.
Steroid injection at the same sitting, to slow the scar’s return before it begins.
On instruments
I make the incisions with a laser. Partly that is because I have one — but the real reasons are that it is precise, and that it stops the bleeding as it cuts, so the view stays superb. A great view is what lets you cut accurately.
Many colleagues around the world do not have a laser, and I want to be clear that simple cuts work too. The technique matters more than the instrument.
One thing to avoid
Do not use a debrider. It is far too easy to remove more tissue than you meant to, and a circumferential injury is precisely what promotes cicatricial contracture — and recurrence. The whole point of dividing rather than excising is to avoid creating the injury you are trying to treat.
What to expect afterward
On its own, this approach often settles into a yearly trip to the operating room, sometimes more often. Paired with serial office steroid injections, many patients avoid further surgery altogether.
Why this diagnosis is so often made late — a case: When symptoms of cough and hoarseness might be hidden
For general information about what to expect with microlaryngoscopy, anesthesia, and recovery, see the Surgical Microlaryngoscopy overview.