Abstract：
OBJECTIVE: Post intubation phonatory insufficiency (PIPI) or posterior glottic diastasis describes posterior glottic insufficiency (PGI) caused by prolonged intubation causing medial arytenoid ulceration, mucosal scarring, and incomplete cricoarytenoid joint adduction. The purpose of this review is to showcase diagnostic findings, surgical rehabilitation, and gaps in our treatment algorithm of PIPI.
METHODS: Embase, PubMed, Scopus, Web of Science.
METHODS: Two independent reviewers completed a systematic search of the literature studying PIPI. Reported intubation history, laryngeal defect, clinical symptoms, surgical intervention, and outcomes were gathered from included studies.
RESULTS: Nine studies met our inclusion criteria for full review, (45 patients) all of which were case reports/series. All patients had posterior glottic defects, most commonly loss of medial arytenoid tissue, causing varying degrees of PGI. Eleven patients had vocal fold (VF) immobility or hypomobility. Treatment interventions were observation (1), speech therapy (2), VF or posterior glottic injection augmentation (15), medialization laryngoplasty (4), arytenoid repositioning (6), endoscopic (19) or open (3) posterior cricoid reduction, local mucosal rotation flap (11), or free mucosal graft (2) to fill the glottic defect. Observation, voice therapy, and augmentation or type 1 laryngoplasty failed to improve symptoms. Other surgical techniques improved symptoms with varying outcomes.
CONCLUSIONS: PIPI is a difficult injury to diagnosis and treat. Conservative measures and augmentation/laryngoplasty often fail to fix the PGI. Our review supports symptom improvement with reconstruction of the posterior glottic defect with cricoid reduction or mucosal grafts. Future investigation is needed to better define the diagnosis and successful treatment algorithm. Laryngoscope, 134:2048-2058, 2024.
METHODS: Embase, PubMed, Scopus, Web of Science.
METHODS: Two independent reviewers completed a systematic search of the literature studying PIPI. Reported intubation history, laryngeal defect, clinical symptoms, surgical intervention, and outcomes were gathered from included studies.
RESULTS: Nine studies met our inclusion criteria for full review, (45 patients) all of which were case reports/series. All patients had posterior glottic defects, most commonly loss of medial arytenoid tissue, causing varying degrees of PGI. Eleven patients had vocal fold (VF) immobility or hypomobility. Treatment interventions were observation (1), speech therapy (2), VF or posterior glottic injection augmentation (15), medialization laryngoplasty (4), arytenoid repositioning (6), endoscopic (19) or open (3) posterior cricoid reduction, local mucosal rotation flap (11), or free mucosal graft (2) to fill the glottic defect. Observation, voice therapy, and augmentation or type 1 laryngoplasty failed to improve symptoms. Other surgical techniques improved symptoms with varying outcomes.
CONCLUSIONS: PIPI is a difficult injury to diagnosis and treat. Conservative measures and augmentation/laryngoplasty often fail to fix the PGI. Our review supports symptom improvement with reconstruction of the posterior glottic defect with cricoid reduction or mucosal grafts. Future investigation is needed to better define the diagnosis and successful treatment algorithm. Laryngoscope, 134:2048-2058, 2024.
摘要：
目的：插管后发声功能不全（PIPI）或后声门分离描述了由长时间插管引起的后声门功能不全（PGI），粘膜瘢痕,和不完全的环叉关节内收。这篇综述的目的是展示诊断结果，外科康复,和我们的PIPI治疗算法中的差距。
方法：Embase，PubMed,Scopus,Web的科学。
方法：两名独立的审稿人完成了对PIPI研究文献的系统搜索。报告的插管史，喉缺损,临床症状,手术干预,结果来自纳入的研究.
结果：九项研究符合我们全面审查的纳入标准，（45例）均为病例报告/系列。所有患者都有声门后部缺损,最常见的是内侧软骨组织的损失，导致不同程度的PGI。11例患者有声带（VF）不活动或灵活性不足。治疗干预措施观察(1)，言语治疗（2），VF或声门后部注射增强（15），中膜喉成形术（4），Arytenoid重新定位（6），内窥镜（19）或开放（3）后环状软骨复位术，局部粘膜旋转皮瓣（11），或游离的粘膜移植物（2）来填充声门缺损。观察,嗓音治疗,增大或1型喉成形术未能改善症状。其他手术技术改善了症状，结果不同。
结论：PIPI是一种难以诊断和治疗的损伤。保守措施和增大/喉成形术通常无法修复PGI。我们的评论支持通过环状软骨减少或粘膜移植物重建后声门缺损来改善症状。需要未来的研究来更好地定义诊断和成功的治疗算法。喉镜,134：2048-2058，2024。
方法：Embase，PubMed,Scopus,Web的科学。
方法：两名独立的审稿人完成了对PIPI研究文献的系统搜索。报告的插管史，喉缺损,临床症状,手术干预,结果来自纳入的研究.
结果：九项研究符合我们全面审查的纳入标准，（45例）均为病例报告/系列。所有患者都有声门后部缺损,最常见的是内侧软骨组织的损失，导致不同程度的PGI。11例患者有声带（VF）不活动或灵活性不足。治疗干预措施观察(1)，言语治疗（2），VF或声门后部注射增强（15），中膜喉成形术（4），Arytenoid重新定位（6），内窥镜（19）或开放（3）后环状软骨复位术，局部粘膜旋转皮瓣（11），或游离的粘膜移植物（2）来填充声门缺损。观察,嗓音治疗,增大或1型喉成形术未能改善症状。其他手术技术改善了症状，结果不同。
结论：PIPI是一种难以诊断和治疗的损伤。保守措施和增大/喉成形术通常无法修复PGI。我们的评论支持通过环状软骨减少或粘膜移植物重建后声门缺损来改善症状。需要未来的研究来更好地定义诊断和成功的治疗算法。喉镜,134：2048-2058，2024。
