SASS Clinical Note #7
Redundant Postcricoid Mucosal Epithelium Or Shar Pei Larynx
A new clinical entity, Shar Pei Larynx, has been reported by Yiu et al. (2019) but it may not be necessarily new to endoscopists. M.S. recently discovered the patient shown above. The endoscopic assessment reveals thick, almost fatty-appearing, layers of mucosa growing or accumulating in the posterior cricoid space and supraglottic areas. We have referred to this as excessive and redundant esophageal tissue originating from the proximal esophagus into the posterior cricoid space, and that is incorrect.
Yui et al. describe this clinical entity as having an extremely redundant and inflamed mucosa of the arytenoids, aryepiglottic folds, and/or posterior cricoid region with 3 or more linear mucosal folds and mucosal overhang obscuring the interarytenoid space. With linear markings or wrinkles similar to a “wrinkled dog” or “Shar Pei Larynx.” Their hypothesis is that Shar Pei larynx may develop more in patients with comorbidities of larynx-pharynx reflux (LPR), diabetes mellitus, tobacco abuse, and either risk factors for or a diagnosis of obstructive sleep apnea (OSA). Other studies have reported similar findings including redundant and flaccid aryepiglottic folds associated with neuromuscular dysfunctions from CNS injury, i.e. meningitis to trauma and anoxic brain injury but these appear to be different than Shar Pei larynx. Of most concern with this condition is possible upper airway restriction with stridor requiring surgery for removal. However, in the Yiu et al. report, none of the patients in their had severe obstructive symptoms.
Finally, the Yiu paper suggested that a large number of their cohort with Shar Pei larynx findings also had symptoms of reflux disease. Classic findings of LPR were described by the Reflux Symptom Index as laryngeal edema (localized or diffuse), posterior commissure hypertrophy, erythema or hyperemia, and granulation tissue. Thus, they propose that redundant and edematous supraglottic and posterior cricoid mucosa seen in the Shar Pei larynx may be an indication of poorly controlled LPR.
Yiu, Y., Tibbetts, K. M., Simpson, C. B., & Matrka, L. A. (2019). Shar Pei Larynx: Supraglottic and Postcricoid Mucosal Redundancy and Its Association With Medical Comorbidities. The Annals of otology, rhinology, and laryngology, 128(2), 121–127.https://doi.org/10.1177/0003489418810893