Dr David Vokes: Airway Disorders, Problems and Conditions Treated

The Upper Airway is that part of the airway (the breathing passage) that extends from the nose to the trachea, and includes the nasal cavities, the throat (the pharynx) and the voicebox (the larynx). Narrowing in the upper airway may cause serious symptoms, such as shortness of breath (especially on exertion) and stridor, a high pitched sound heard during inspiration (breathing in or inhaling), or during both inspiration and expiration (taking a breathing out or exhaling).

Narrowing of the larynx caused by scarring (posterior glottic stenosis or subglottic stenosis), narrowing of the trachea caused by scarring (tracheal stenosis), bilateral vocal fold paralysis, throat infections and tumours in the throat are the main conditions associated with stridor. These conditions can be life threatening, especially if symptoms develop suddenly and quickly.

For more information about specific airway conditions, please click on a link below:

Subglottic Stenosis

Subglottic stenosis is narrowing of the part of the larynx (voicebox) that is below the vocal folds. This may be caused by trauma (from intubation), or by inflammatory conditions such as idiopathic subglottic stenosis, granulomatosis with polyangiitis, or sarcoidosis.

Most people with subglottic stenosis are treated initially with dilation (stretching) of the area of narrowing. The area of narrowing is dilated (stretched) using an airway balloon dilator. This is performed via the mouth using a laryngoscope under general anaesthetic in the operating room. Dr Vokes also injects steroid medication into the area that has been dilated to prolong the duration of effect, as, in most cases, these stenoses tend to recur (the narrowing forms again). This surgical procedure is called Microlaryngoscopy & Dilation of Stenosis.

After the stenosis has been dilated, it is also possible to perform further steroid injections into the stenosis to help slow the rate of recurrence of the stenosis. These injections may be performed in the office using with local anaesthetic. A course of 5 or 6 injections, each administered every few weeks, is recommended. This technique is referred to as serial intralesional steroid injections, or SILSI.

When dilation of a subglottic stenosis is not effective, or is not possible, a Cricotracheal Resection may be performed. This is a procedure in which the narrowed part of the subglottis is excised (removed) and then the trachea is rejoined to the larynx to restore the airway to its normal size. This is performed through an incision in the front of the neck under general anaesthetic in the operating room. The recovery postop requires several days in hospital afterwards, and some restriction in neck movements for six weeks after the surgery.

Subglottic stenosis is narrowing of the part of the larynx (voicebox) that is below the vocal folds. This may be caused by trauma (from intubation), or by inflammatory conditions such as idiopathic subglottic stenosis, granulomatosis with polyangiitis, or sarcoidosis.

Most people with subglottic stenosis are treated initially with dilation (stretching) of the area of narrowing. The area of narrowing is dilated (stretched) using an airway balloon dilator. This is performed via the mouth using a laryngoscope under general anaesthetic in the operating room. Dr Vokes also injects steroid medication into the area that has been dilated to prolong the duration of effect, as, in most cases, these stenoses tend to recur (the narrowing forms again). This surgical procedure is called Microlaryngoscopy & Dilation of Stenosis.

After the stenosis has been dilated, it is also possible to perform further steroid injections into the stenosis to help slow the rate of recurrence of the stenosis. These injections may be performed in the office using with local anaesthetic. A course of 5 or 6 injections, each administered every few weeks, is recommended. This technique is referred to as serial intralesional steroid injections, or SILSI.

When dilation of a subglottic stenosis is not effective, or is not possible, a Cricotracheal Resection may be performed. This is a procedure in which the narrowed part of the subglottis is excised (removed) and then the trachea is rejoined to the larynx to restore the airway to its normal size. This is performed through an incision in the front of the neck under general anaesthetic in the operating room. The recovery postop requires several days in hospital afterwards, and some restriction in neck movements for six weeks after the surgery.

Bilateral Vocal Fold Paralysis

Narrowing of the airway may also result from paralysis of both vocal folds, leading to an inability to fully open the vocal folds to allow for an adequate intake of air.

Bilateral vocal fold paralysis most commonly occurs as a complication of surgery, but may also result from intubation, neurological disorders or from cancers affecting organs near to the larynx.

Bilateral vocal fold paralysis is often treated with laser surgery to one of both vocal folds to enlarge the size of the airway.  This is performed via the mouth using a laryngoscope under general anaesthetic in the operating room. Therefore, this procedure is called Microlaryngoscopy & Laser Cordotomy.

When laser treatment of bilateral vocal fold paralysis is not effective, or is not possible, a Combined Glottic Reconstruction may be performed. This is a procedure in which the front of the larynx is opened to allow access to the back of the larynx (posterior glottis). The back of the larynx is then split in half, and a piece of cartilage (usually harvested from the chest wall) is inserted between the two halves to enlarge the size of the airway. Part of the lining of the throat is then advanced into the larynx to cover the cartilage to improve healing. This procedure is performed through an incision in the front of the neck under general anaesthetic in the operating room. The recovery postop requires several days in hospital afterwards, and a temporary tracheostomy for several weeks after the surgery.

Posterior Glottic Stenosis

Posterior Glottic Stenosis is narrowing of the part of the larynx (voicebox) that is between the back part of the vocal folds. This causes a restriction in the opening of the vocal folds. This is usually caused by trauma from intubation (placement of a breathing tube).

People with posterior glottic stenosis may be treated initially with dilation (stretching) of the area of narrowing. The area of narrowing is dilated (stretched) using an airway balloon dilator. This is performed via the mouth using a laryngoscope under general anaesthetic in the operating room. Dr Vokes also injects steroid medication into the area that has been dilated to prolong the duration of effect, as, in most cases, these stenoses tend to recur (the narrowing forms again). This procedure is called Microlaryngoscopy & Dilation of Stenosis.

When dilation or laser treatment of a posterior glottic stenosis is not effective, or is not possible, a Combined Glottic Reconstruction may be performed. This is a procedure in which the front of the larynx is opened to allow access to the back of the larynx (posterior glottis). The back of the larynx is then split in half, and a piece of cartilage (usually harvested from the chest wall) is inserted between the two halves to enlarge the size of the airway. Part of the lining of the throat is then advanced into the larynx to cover the cartilage to improve healing. This procedure is performed through an incision in the front of the neck under general anaesthetic in the operating room. The recovery postop requires several days in hospital afterwards, and a temporary tracheostomy for several weeks after the surgery.

Tracheal Stenosis

Tracheal Stenosis is narrowing of part of the trachea (the windpipe). This is usually caused by trauma, from either intubation (placement of a breathing tube) or tracheostomy.

Most people with tracheal stenosis are treated initially with dilation (stretching) of the area of narrowing. The area of narrowing is dilated (stretched) using an airway balloon dilator. This is performed via the mouth using a laryngoscope under general anaesthetic in the operating room. Dr Vokes also injects steroid medication into the area that has been dilated to prolong the duration of effect, as, in most cases, these stenoses tend to recur (the narrowing forms again).This procedure is called Microlaryngoscopy & Dilation of Stenosis.

When dilation of a tracheal stenosis is not effective, or is not possible, a Tracheal Resection is performed. This is a procedure in which the narrowed part of the trachea is excised (removed) and then the trachea is rejoined to restore the trachea to its normal size. This is performed through an incision in the front of the neck under general anaesthetic in the operating room. The recovery postop requires several days in hospital afterwards, and some restriction in neck movements for six weeks after the surgery.

Tracheal Stenosis is narrowing of part of the trachea (the windpipe). This is usually caused by trauma, from either intubation (placement of a breathing tube) or tracheostomy.

Most people with tracheal stenosis are treated initially with dilation (stretching) of the area of narrowing. The area of narrowing is dilated (stretched) using an airway balloon dilator. This is performed via the mouth using a laryngoscope under general anaesthetic in the operating room. Dr Vokes also injects steroid medication into the area that has been dilated to prolong the duration of effect, as, in most cases, these stenoses tend to recur (the narrowing forms again).This procedure is called Microlaryngoscopy & Dilation of Stenosis.

When dilation of a tracheal stenosis is not effective, or is not possible, a Tracheal Resection is performed. This is a procedure in which the narrowed part of the trachea is excised (removed) and then the trachea is rejoined to restore the trachea to its normal size. This is performed through an incision in the front of the neck under general anaesthetic in the operating room. The recovery postop requires several days in hospital afterwards, and some restriction in neck movements for six weeks after the surgery.

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