Single-Stage Management of Dual-Level Laryngeal Stenosis: A Surgical Challenge

Anterior glottic web and subglottic stenosis are distinct airway pathologies that may rarely coexist, resulting in dual-level airway obstruction and posing significant management challenges, with staged surgical approaches traditionally recommended. A 25-year-old female presented with progressive dyspnea, voice changes, and exertional stridor over three months, with a history of treated pulmonary tuberculosis. Flexible laryngoscopy revealed an anterior glottic web (Cohen’s Stage II) and subglottic stenosis (Cotton–Myer Grade II), which was confirmed on imaging as circumferential subglottic narrowing. The patient underwent a single-stage surgical procedure involving Elective Tracheostomy followed by Endoscopic Coblation-assisted incision and balloon dilatation of the subglottic stenosis, along with excision of the glottic web and placement of a Montgomery keel via laryngofissure to prevent re-adhesion. The keel was removed after six weeks, and at three-month follow-up, the patient demonstrated significant improvement in airway patency and was successfully decannulated, remaining asymptomatic at six months. This case highlights that single-stage management of dual-level laryngeal stenosis using Coblation-assisted dilatation combined with keel placement is a safe and effective approach in selected patients, potentially reducing the need for multiple procedures while achieving favourable functional outcomes.