The Laryngoscope V C 2011 The American Laryngological, Rhinological and Otological Society, Inc. Lysis of Interarytenoid Synechia (Type I Posterior Glottic Stenosis): Vocal Fold Mobility and Airway Results Tanya K. Meyer, MD; Jeffrey Wolf, MD Background: The Type I Posterior Glottic Stenosis (PGS-I) is a well-described but uncommon clinical entity. Despite this, there is little known about the outcome of surgical treatment. Methods: Retrospective case series. Results: Thirteen cases met inclusion criteria. All but one patient had a tracheostomy at the time of initial evaluation. At the postoperative visit, seven patients (54%) had completely normal vocal fold motion. Of the verbal patients, 6 (50%) had normal vocal function as reported by both the patient/caregiver and the physician, and 10 (83%) patients were successfully decannulated. Conclusions: Patients with an isolated interarytenoid synechia have an excellent prognosis with regard to decannula- tion. Although many patients regain normal vocal fold motion and a return to their preintubation vocal function, a significant proportion can have persistent deficits in vocal fold mobility and some level of dysphonia. This report represents the largest known series of PGS-I cases. Key Words: Posterior glottic stenosis, glottic scar, cricoarytenoid joint ankylosis, cricoarytenoid joint immobility, tracheostomy, voice, decannulation, type I posterior glottic stenosis. Level of Evidence: 4. Laryngoscope, 121:2165–2171, 2011 INTRODUCTION Posterior glottic stenosis (PGS) can be described as total or partial fixation of the vocal folds in an adducted position as a result of one or more of the following: 1) fibrous interarytenoid adhesion, 2) scarring and contrac- ture of the posterior glottic structures, and/or 3) cricoarytenoid joint fixation. These conditions cause limi- tation of vocal fold motion with subsequent airway restriction. Depending on the structures involved, PGS is most commonly classified into four types as per Bog- dassarian and Olson. 1 The type I posterior glottic stenosis (PGS-I) consists of an interarytenoid fibrous adhesion or synechia with a patent aperture posteriorly. Types II through IV develop progressive involvement of additional structures of the posterior glottis (Fig. 1). Studies to date regarding surgical management of PGS have reported mixed series (all types) with a 70% to 90% 1–4 decannulation rate. The treatment and prog- nosis of the PGS-I is anecdotally felt to be dramatically different from the more advanced types. 5 In the most favorable case, the interarytenoid synechia of the PGS-I can be divided with full return of vocal fold mobility and laryngeal function. In general, it is felt that more com- plex reconstructive procedures are required for types II– IV. There have been no dedicated reports detailing the clinical characteristics and outcomes of surgical manage- ment of the PGS-I with resection of the interarytenoid synechia. This report summarizes our experience with the airway and voice outcomes in this selected group of patients. METHODS Patients Institutional review board (IRB) approval for this project was obtained from University of Maryland Medical Center in Baltimore, Maryland. This was a retrospective review of all cases of surgically treated PGS-I at a single tertiary care center between the dates of July 1, 2005 to July 30, 2009. The patients were identified using using ICD-9 codes 519.0, 478.74, and 478.3, and the CPT code 31541. Medical records were evaluated to determine a diagnosis of PGS-I confirmed by the description of an interarytenoid adhesion in the operative note. A database was created that included patient age, gender, tracheostomy status, and primary diagnosis at the principle episode of illness. Preoperative and postoperative clinic notes were evaluated for decannulation status, voice, swallowing, and airway results. Surgical Technique The following describes the general techniques used for most patients in this series. Patients were given 10 mg of dexa- methasone and a single dose of intravenous antibiotics (3 g From the Department of Otolaryngology Head & Neck Surgery ( T. K. M.), University of Washington, Seattle, Washington, U.S.A.; Department of Otolaryngology Head & Neck Surgery (J.W.), University of Maryland, Baltimore, Maryland, U.S.A. Editor’s Note: This Manuscript was accepted for publication May 20, 2011. This article was presented as a poster at the Spring 2011 COSM meeting as part of the American Laryngological Association. There was no financial support or funding for this project. Tanya Meyer and Jeffrey Wolf have no financial disclosures. The authors have no conflicts of interests to disclose. Send correspondence to Dr. Tanya K. Meyer, Department of Oto- laryngology Head & Neck Surgery, University of Washington Medical Center, Box 356515, Seattle, WA 98195-6515. E-mail: meyertk@uw.edu DOI: 10.1002/lary.22036 Laryngoscope 121: October 2011 Meyer and Wolf: Type I PGS 2165