(A706) Case of Severe Supraglottic Stenosis: Caused by a Hypopharynx Inlet Patch or Laryngeal Pemphigoid?

Introduction: An inlet patch (IP) is an abnormal area of heterotopic gastric mucosa in the esophagus typically located below the upper esophageal sphincter. While generally asymptomatic, symptoms can consist of esophageal manifestations, including dysphagia and esophagitis. IPs are not commonly associated with esophageal strictures or upper airway disease. Laryngeal pemphigoid (LP) is an autoimmune disorder in which antibodies target the basement membrane of the mucosal epithelium, leading to blister formation and subsequent airway scarring that can be life-threatening.

Methods: Case report

Results: A 74 year old female presented with dyspnea, throat pain, and dysphagia. Flexible laryngoscopy demonstrated severe hypopharyngeal and supraglottic stenosis. She underwent laser ablation and balloon dilation for symptom management. During the procedure to open the stenosed airway, a raised tissue mass at the posterior cervical esophagus was identified and removed, which was confirmed to be a cervical inlet patch by pathology. Post-operatively, she noted symptomatic improvement at her one month follow-up. At the three month follow-up, some restenosis was seen. She underwent another laser ablation and balloon dilation with steroid injections into the hypopharyngeal scar region. Tissue biopsy showed linear IgA deposits along the basement membrane with absent IgG and C3, suggesting linear IgA bullous dermatosis.

Conclusions: Inlet patches can cause various symptoms, primarily related to excess acid production. Complications can include stricture, ulceration, mucosal fibrosis, metaplasia, web formation, or esophageal perforation. Despite its discovery in the hypopharynx, it is critical to evaluate for other rare causes of scarring in the airway such as autoimmune pemphigoid.