RESUMO
Introduction: upper airway obstruction is a continuous challenge in diagnosis especially if surgical intervention is required. [1-2-3-4-5] Virtual laryngoscopy [VL] is a technique for creating computer simulations of anatomy from radiological image data and viewing those simulations in a way that is analogous to conventional endoscope.[6]
Aim of the work: the aim of this work was to evaluate the results of surgical reconstruction and to compare the findings with virtual laryngoscopy [VL] and conventional endoscopy in diagnosis of upper air way obstruction
Patients and methods: a prospective study was done at Mansoura University Hospitals at Departments of Otolaryngology and Cardiothoracic surgery, on thirty two patients with an age range of 14-72 years
Results: patients presented with upper airway obstruction, 15 cases of laryngeotracheal trauma, advanced laryngeal carcinoma [10 patients], 2patients of cervical tracheal carcinoma, and granulomatous lesions [5 patients]. Fiber optic and rigid endoscopy were attempted in all patients. Biopsy was done for 28 patients to confirm diagnosis. Spiral CT was performed with slice thickness 2 mm, pitch 1.2mm, and reconstruction .interval 1.5mm. CT data was transferred to workstation software to analyze both ante-grade and retrograde end luminal VL with conventional endoscopy and operative findings. Patients presented with cancer and trauma were operated for laryngectomy and laryngotrache0-plasty. Rigid endoscopy showed upper airway obstruction in 8 patient's trans glottis carcinoma [65%], 1 patients in granulomatous lesions [18%], and 3 [20%] cases of trauma with total success rate 41%. VL showed all luminal obstruction. Only three cases the narrowed segment length was less than operative measurement with total accuracy [94%]. Operation was done for traumatic and cancer patients, comparing the rustles of operative finding and VL
Conclusion: we conclude that high resolution and multiple image of VL are depicting the intraluminal and transmural extent of laryngeal disease non- invasively especially in traumatic causes. Surgical repair is a challenging procedure, however, it could be done with a good results and minimal morbidity and mortality. The mobilization of the trachea and larynx is essential step for closure sutures without tension is highly important. The usage of neck collar in the opposite manner is useful to prevent patient from neck hyperextension and disruption of tracheal sutures