Two Cases of Laryngeal Injury Due to Endotracheal Intubation that Required Surgical Treatment

Endotracheal intubation can induce various laryngeal injuries. Treatments for such injuries differ depending on the injured site and duration elapsed after intubation. We herein report two cases of laryngeal injury due to endotracheal intubation that required surgical treatment. Case 1 was an 80-year-old woman who suffered from dyspnea 2 days after surgery for lung cancer. She had been intubated with a thick, double-lumen endotracheal tube, and had exhibited persistent hoarseness since the surgery. Upon laryngeal endoscopy, her airway had almost completely closed due to membranous granulation covering the subglottis. Tracheostomy, removal of the granulation tissue, and local injection of triamcinolone acetonide were performed to secure the airway. Although several rounds of granulation tissue removal were required to achieve a safe airway, the tracheostoma was ultimately successfully closed. Case 2 was a 55-year-old man who had been intubated for 11 days after surgery for esophageal cancer. Hoarseness was evident immediately after extubation. Laryngeal endoscopy confirmed bilateral vocal fold paralysis at the paramedian position, but the airway was narrowly maintained. During follow-up, vocal fold mobility gradually improved for a time. However, bridge-like granulation appeared in the posterior glottis later, and vocal fold abduction gradually became impaired bilaterally. Removal of the granulation tissue and topical triamcinolone acetonide injection were performed to prevent scar formation. After the surgery, the vocal fold mobility fully recovered without recurrence of granulation tissue. Laryngeal injuries should be suspected when hoarseness is apparent after extubation, and surgical treatment should be considered in cases involving airway problems.