Transoral laser microsurgery of laryngopharyngeal chemical injury: Case series

Introduction and importance: The accidental or intentional consumption of caustic substances is a rare but serious medical emergency with potentially severe consequences and high mortality rates. While damage to the gastro-esophagus from these substances is well-recognized, injury to the pharyngolaryngeal structure is less common. Still, it poses a significant risk to life and has not been extensively documented. We presented the surgical treatments for these injuries and assessed patient outcomes following the intervention. Case Presentation: Ten patients were treated at the ENT department in Algiers, Algeria, from January 2018 to November 2023, presented with pharyngolaryngeal and oesophageal narrowing due to chemical substances and were referred by general surgeons for pharyngolaryngeal stenosis surgery in preparation for oesophageal reconstruction. We retrospectively analyzed the clinical data, surgical interventions, and patient outcomes following research to the PROCESS reporting guidelines. Clinical Discussion: Our study revealed a higher prevalence among females with a median age of 25. Intentional ingestion of caustic substances was the most common cause of 7 patients, and 8 of 10 patients required a tracheostomy. All patients had a healthy glottis, without scar and mobility conset (confirmed by endoscopy and CT) and received a feeding jejunostomy. Following endoscopic and CT assessments, all patients underwent transoral laser microsurgery (TLM), with a hospital stay of 24 hours and positive surgical outcomes. Two patients required additional procedures, but after one month, all patients demonstrated highly satisfactory results with almost complete resolution of hypopharyngeal and laryngeal stenosis, decannulation for tracheostomized individuals, and referral to general surgery for further management. Conclusion: Caustic pharyngolaryngeal and esophageal stenosis is challenging for specialistic teamwork. Otolaryngologists can play a crucial role in managing these patients by utilizing TLM to help address this difficult condition.