Larengeal Stenoz
Özet
Larengeal stenoz (LS), supraglottis, glottis ve subglottis bölgelerini etkileyen, konjenital veya sonradan edinilmiş üst havayolu daralmasıdır. En yaygın edinilmiş etiyoloji post-entübasyon travması olup, inflamatuar hastalıklar, radyoterapi ve cerrahi işlemler de stenoza yol açabilir. Dispne, stridor, egzersiz intoleransı ve ses değişiklikleri en belirgin klinik semptomlardır. Pediatrik popülasyonda en sık subglottik alanda (krikoid seviyesi) daralma görülürken, erişkinlerde vokal kord seviyesi ön plana çıkar. Tanıda fizik muayene, larengoskopi ve BT/MRG görüntüleme yöntemleri kullanılır; tedaviye dirençli astım vakalarında LS mutlaka dışlanmalıdır. Stenoz derecesi ELS ve Cotton-Myer gibi sistemlerle sınıflandırılır. Tedavi yaklaşımı standart olmayıp, hastanın profiline ve darlığın evresine göre belirlenir. Erken, yumuşak ve sınırlı lezyonlarda lazer kesi, balon dilatasyon ve topikal steroid enjeksiyonlarını içeren transoral endoskopik tedaviler %66-80 başarı oranıyla tercih edilir. Ancak kıkırdak iskelet kaybı, olgun skarlar veya 1 cm'den uzun darlıklarda laringotrakeal rekonstrüksiyon (LTR) ve parsiyel krikotrakeal rezeksiyon (PCTR) gibi açık cerrahi prosedürler endikedir. Tedavinin temel amacı, havayolu açıklığını sağlamak, ses kalitesini korumak ve yutma fonksiyonlarını sürdürmektir.
Laryngeal stenosis (LS) is a congenital or acquired narrowing of the upper airway that affects the supraglottic, glottic, and subglottic regions. Post-intubation trauma stands as the most common acquired etiology, though inflammatory diseases, radiotherapy, and prior surgeries also contribute to stenosis. Dyspnea, stridor, exercise intolerance, and voice changes represent the primary clinical symptoms. While the subglottic region at the cricoid level is the narrowest point in pediatric patients, the vocal cords at the glottic level are mostly affected in adults. Diagnosis relies on comprehensive physical examination, laryngoscopy, and CT/MRI imaging; furthermore, LS must be ruled out in treatment-resistant asthma cases. Severity is classified using the ELS and Cotton-Myer grading systems. Treatment management is highly individualized without a single standard protocol. Transoral endoscopic interventions, including laser incisions, balloon dilations, and adjuvant topical steroid injections, yield a 66-80% success rate in early, soft, and limited lesions. However, open surgical procedures such as laryngotracheal reconstruction (LTR) and partial cricotracheal resection (PCTR) are strictly indicated for mature scars, cartilage loss, or stenotic segments exceeding 1 cm. The ultimate therapeutic goals are restoring airway patency, preserving acceptable voice quality, and maintaining proper swallowing functions.
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