Epiglottic Repositioning Procedure for Supraglottic Stenosis/Collapse

Objectives: Supraglottic stenosis/collapse is an uncommon condition. It can be difficult to detect and may be a cause of failed decannulation following tracheostomy. We present a novel technique to correct supraglottic stenosis/collapse. Methods: We performed a retrospective analysis of the records of patients in whom attempts at decannulation had failed at our center between 2003 and 2007. A subgroup with supraglottic stenosis/collapse with posterior displacement of the base of the epiglottis was identified. Our epiglottic repositioning procedure was performed in these patients. Through an external incision, the epiglottis was divided above the anterior commissure and attached to the superior border of the thyroid cartilage. Results: Eight decannulation failures out of 36 attempted decannulations were identified. Three of these 8 cases involved supraglottic stenosis/collapse due to posterior displacement of the base of the epiglottis. Correction of the supraglottic stenosis/collapse led to successful decannulation in all cases. Conclusions: Diagnosis-directed laryngoscopy is required to identify this condition. We describe precisely a technique of repositioning the epiglottis to correct supraglottic stenosis/collapse.