인두 협착에 대한 경구강 비디오 후두경 수술 치료 2예
Transoral Videolaryngoscopic Surgery for Pharyngeal Stenosis: Two Case Studies
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Pharyngeal stenosis (PS) is an unwanted consequence of chemo-radiation treatment of pharyngeal carcinomas, or a rare complication of rheumatic diseases. We present two cases of PS treated with the novel use of transoral videolaryngoscopic surgery (TOVS). In the first case, a 63-year-old male presented with dysphagia due to PS after adjuvant chemo-radiation therapy. Laryngoscopy revealed fibrotic bands obstructing both pyriform sinuses. Impaired swallowing reflex and weak pharyngeal muscle during the pharyngeal phase were identified in VFSS. To secure the oropharyngeal space, the fibrotic band was removed using a monopolar cautery with TOVS. The second case involved a 49-year-old female afflicted with IgG4-related rheumatic disease who presented with dysphagia. A pharyngeal stricture between the epiglottis and adjacent lateral pharyngeal wall was accountable for stenosis of the oropharynx. Adhesiolysis around the pharyngeal aperture was performed during TOVS. In both cases, steroid was injected into the resection site to prevent subsequent adhesions. Both patients resumed oral intake of a soft meal the day after surgery, and eventually progressed to regular meals. Stable pharyngeal function was demonstrated after 2 months. No major complications from the surgery were observed in both cases. We propose that TOVS is a feasible surgical option to resolve and prevent PS, and the application of TOVS can potentially be expanded for oropharyngeal lesions
Abstract
Pharyngeal stenosis (PS) is an unwanted consequence of chemo-radiation treatment of pharyngeal carcinomas, or a rare complication of rheumatic diseases. We present two cases of PS treated with the novel use of transoral videolaryngoscopic surgery (TOVS). In the first case, a 63-year-old male presented with dysphagia due to PS after adjuvant chemo-radiation therapy. Laryngoscopy revealed fibrotic bands obstructing both pyriform sinuses. Impaired swallowing reflex and weak pharyngeal muscle during the pharyngeal phase were identified in VFSS. To secure the oropharyngeal space, the fibrotic band was removed using a monopolar cautery with TOVS. The second case involved a 49-year-old female afflicted with IgG4-related rheumatic disease who presented with dysphagia. A pharyngeal stricture between the epiglottis and adjacent lateral pharyngeal wall was accountable for stenosis of the oropharynx. Adhesiolysis around the pharyngeal aperture was performed during TOVS. In both cases, steroid was injected into the resection site to prevent subsequent adhesions. Both patients resumed oral intake of a soft meal the day after surgery, and eventually progressed to regular meals. Stable pharyngeal function was demonstrated after 2 months. No major complications from the surgery were observed in both cases. We propose that TOVS is a feasible surgical option to resolve and prevent PS, and the application of TOVS can potentially be expanded for oropharyngeal lesions
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