Laryngotracheal paratubal air envelope: a useful sign in voice and airway reconstructive surgery.

Aphonia, dysphonia, and laryngotracheal stenosis with upper airway compromise are diagnosed with increasing frequency. Endoscopic surgical reconstructive techniques accompanied by tracheal T-tube stenting successfully restore voice, airway function, and structure. Timing of tracheal T-tube removal remains controversial, particularly when the tip of the upper arm of the optimally sized T-tube is placed in a critical supraglottic position. The appearance of an air envelope, manifested as linear air densities between the outside wall of the T tube and the inside wall of the larynx and trachea, has proven to be a useful and reliable indicator of laryngotracheal structural integrity and functional stability. The paratubal air envelope sign is demonstrated by soft-tissue neck radiographs and delta scan topograms. This objective sign, videolaryngoscopy/stroboscopy, and clinical judgment combine to determine optimal timing for tracheal T-tube removal.