Paradoxical movements of the epiglottis--a rare cause of respiratory obstruction and its surgical treatment.

INTRODUCTION: The aim of this paper was to present a rare disorder of epiglottis function as a cause of breathing disorders and a manner of dealing with this problem.

CASE REPORT: A 59-year-old male patient had breathing disorders in the form of short cessations of breathing two months after a cardiac surgery. He could not tolerate even a slight physical effort. Indirect laryngoscopy and video endoscopy performed with a rigid endoscope indicated paradoxical movements of epiglottis, which closed the entrance to the larynx and caused short cessations of breathing. The patient underwent a subtotal resection of the epiglottis with an argon plasma scalpel. Directoscopy of the larynx was performed under general endotracheal anesthesia. After three weeks, the patient was without any difficulties. The check-up examination after three months showed a small remaining part of the epiglottis. There were no paradoxical movements of the vocal folds: the left vocal fold was shorter, with a loose edge, and the posterior region of the glottis tilted to the left in phonation. The patient reported no breathing disorders three months after the operation.

DISCUSSION: Airway obstruction can be reduced significantly by surgical treatment of a soft or hanging epiglottis. Subtotal resection by argon plasma scalpel resulted in termination of breathing disorders in the patient described in this paper, and it enabled him to continue his normal everyday activities.

CONCLUSION: Paradoxical movements of the epiglottis are a rare cause of breathing disorders. Resection of the epiglottis is a method which gives good therapeutic results.