Posterior glottis stenosis (PGS), which is caused by endotracheal intubation, laryngeal trauma and others, is often misdiagnosed as bilateral vocal fold paralysis (BVFP). Bogdasarian has categorized PGS into four types according to the pathological condition of the larynx. Type Ⅳ, involving ankylosis of the cricoarytenoid joint, is the most common but particularly difficult to manage. PGS can be diagnosed based on a patient’s medical history and findings of fiberoptic laryngoscopy, computed tomography (CT) and direct laryngoscopy without laryngeal electromyography. In patients with tracheostomy, a transtracheal examination of the glottis and subglottis with the tracheotomy tube removed helps discriminate between PGS and BVFP. Ankylosis of the cricroarytenoid joint can be confirmed by the passive movement test during direct a laryngoscopic examination. The posterior glottis in PGS type Ⅳ cannot be widened by Ejnell’s laterofixation procedure. If a patient desires tracheal stoma closure, laterofixation combined with aryntenoidectomy should be performed after the patient has been informed of the possibility of deterioration of the voice quality. Staged surgeries may be considered if necessary. If a patient desires the preservation of their voice quality, tracheal stoma is essential, and arytenoidectomy, which degrades the voice quality less severely than laterofixation, may be required to use a speaking valve constantly.
