Case Discussion

Endoscopic examination revealed bilateral vocal fold immobility, fixed in the midline position, with no visible respiratory chink. Further advancement of the endoscope into the subglottic region demonstrated granulation tissue causing significant narrowing.

Chondronecrosis is a rare but life-threatening complication of endotracheal intubation, with only a few cases documented in the literature. It occurs due to excessive pressure exerted by the endotracheal tube on the cartilage, with the cricoid ring being the most commonly affected. The condition should be suspected in patients presenting with upper airway dyspnoea and a history of intubation. CT imaging plays a crucial role in the diagnostic workup, especially in cases where cricoid chondronecrosis is suspected ¹.

CT scan findings reveal discontinuity of the cricoid arch, distortion of the cartilage outline, chondrolysis, sclerosis, fragmentation, and associated soft tissue swelling as in this case ².

The risk factors for cricoid chondronecrosis include old age, an immunocompromised state, and diabetes. In this case, the patient has diabetes ³.

Early recognition of laryngeal chondronecrosis is essential for effective management. Cartilage changes due to benign processes may resemble the destructive patterns seen in inflammatory or malignant lesions, making clinical context and pathological correlation crucial for accurate differentiation. Management of endotracheal tube-induced chondronecrosis typically includes corticosteroids, nebulization, and physiotherapy. In most cases, surgical interventions such as total laryngectomy or permanent tracheostomy can be avoided ².

The patient underwent conservative management with steroids and was placed under follow-up to monitor the progression of subglottic granulations. If fibrosis develops, excision of the granulations with stent insertion may be considered.

Co-author: Dr Amir Elhamy, Theodor bilharz institute, Egypt.