Causes of upper airway obstruction:
(1) cricoarytenoid arthritis with adduction of the vocal cords
(2) laryngeal edema following intubation
Clinical findings in a patient at risk:
(1) laryngeal pain
(2) hoarseness
(3) dysphagia
(4) dyspnea during exercise
Pulmonary function test findings:
(1) reduced maximal breathing capacity
(2) reduced peak inspiratory flow rate
(3) reduced peak expiratory flow rate
Followup may include:
(1) measurement of the flow volume loop (which will indicate upper airway obstruction)
(2) fiberoptic nasopharyngoscopy by an otolaryngologist
Additional factors that may affect the ability to maintain the airway:
(1) micrognathia
(2) temporomendibular joint arthritis
(3) tongue-related airway obstruction
A patient with evidence of laryngeal disease prior to surgery may benefit from an elective tracheostomy prior to surgery.
