eLarynx

Follow-up 6 weeks after cordectomy type III

Fri, 09 Dec 2022 12:24:45 +0100

65-year old, male, follow-up endoscopy 6 weeks after cordectomy type III and pT1 SCC of the left vocal cord

6 weeks follow up after cordectomy IV right vocal cord

Fri, 09 Dec 2022 12:40:42 +0100

Follow up, 6 weeks after cordectomy type IV for rpT2 cN0 M0 squamous cell carcinoma of the right glottis after failed prior treatment with radiotherapy (67,5Gy)

Total laryngectomy with Endo GIA closure

Sun, 11 Dec 2022 13:10:13 +0100

In this video we show a total laryngectomy performed with the surgeon on the left side in a patient with a T4a larynx cancer. A left hemithyroidectomy was also performed as part of the oncologic surgery. The closure was done using an Endo GIA.

Total laryngectomy

Wed, 16 Nov 2022 14:02:50 +0100

In this video we show a total laryngectomy. The most commonly followed incision for total laryngectomy is the U-shaped incision. If possible, the tracheostomy incision is made separately. The subplatysmal flap is raised superiorly above the level of hyoid bone and inferiorly up to the level of the sternum and clavicular heads. We liberate the specimen by sectioning the strap muscles and the omohyoid muscle inferiorly and dettaching the suprahyoid muscles from the hyoid bone superiorly. How the thyroid is dealt with depends on the extent of the tumor. Once the thyroid is out of the way, we continue to separate the tissues from the specimen laterally. We cut the constrictor muscles out of the thyroid cartilage. We then cut the mucosa over the epiglottis and once the epiglottis is identified we grasp it and retract it with the specimen. To avoid cutting through the tumor or its submucosal extension, the pharynx may be entered contralateral to the tumor. Once the extent of the tumor can be assessed through the opened pharynx, we continue to complete the upper limit of the dissection cutting the pharyngeal mucosa. On the lower end, we create the stoma cutting between two tracheal rings and we then separate the trachea and larynx from the esophagus. Once the specimen is out, we carry out the pharyngeal closure, which is a critical step. Finally we end up creating the stoma and closing the entire wound by layers.

Tracheal resection with a termino-terminal anastomosis

Sun, 11 Dec 2022 12:22:50 +0100

In this video we will show a tracheal resection with a termino-terminal anastomosis in a patient with a chondroma/ low grade chondrosarcoma of the trachea. After the skin incision, we dissect by planes, and we separate the strap muscles in the midline, in order to reach the trachea. To be able to have a full exposure, we cut the thyroid isthmus to move the thyroid lobes laterally. Once the trachea is fully exposed and the tumor well delineated, we cut the trachea above and below the tumor and we reconstruct it by doing a termino-terminal anastomosis, an end-to-end suture, since the length of trachea that needed to be removed in this case allowed this technique.

Polyp of the right vocal fold

Tue, 17 Jan 2023 11:41:02 +0100

This is a case of a patient with a polyp located in a posterior part of the right vocal fold. The lesion was held with forceps and then removed with a CO2 laser with scanner mode

Tracheostomy under local anesthesia

Sun, 11 Dec 2022 17:06:09 +0100

In this video we show a tracheostomy performed under local anesthesia in a patient with supraglottic cancer. This procedure was done as the first step before proceeding with a supraglottic laryngectomy with CO2 laser and bilateral neck dissection.

Cyst of the vallecula

Wed, 18 Jan 2023 11:09:25 +0100

Cyst of the vallecula can be removed using cold still or CO2 laser. In this case, both of these tools were used. First, the epithelium of the vestibular fold was incised using CO2 laser, exposing the cyst capsule, and then, using cold still, the cyst step by step was dissected.

During the dissection of the cyst, it ruptured, but the capsule was preserved, which allowed the lesion to be removed in its entirety.

Posterior cordotomy

Fri, 09 Dec 2022 13:11:17 +0100

26-year old female, synechiae of the posterior commissure after long-term intubation, bilateral posterior cordotomy with laser (pre- vs. postoperative pictures here)

Reinke's edema of both vocal folds

Tue, 17 Jan 2023 12:27:11 +0100

A 49-year-old woman was admitted to the clinic because of hoarseness and a low pitch of voice, with long history of smoking. Stroboscopy confirmed a large Reinke's edema of both vocal folds, bigger on the right side. During the operation the epitelium of the left vocal fold was incised using CO2 laser and scissors. Forceps and suction were used to remove the jelly-like secretion from Reinke's space. Excess mucosa was then removed with scissors.

Tumor of the left vocal fold. Cordectomy type II

Tue, 17 Jan 2023 14:09:25 +0100

A 56-year-old woman was admitted to the otolaryngology department due to a tumor of the left vocal fold. The patient was smoking 20 cigarettes per day for over 30 years. 3 weeks earlier, a biopsywas taken, which showed the neoplastic nature of the lesion. Type II cordectomy was performed using a CO2 laser. In order to improve visualization of the surface of the vocal fold, the vestibular fold was partially removed in the first stage of the operation.

The specimen was sent for histopathological examination.

Medialization thyroplasty under general anesthesia

Wed, 16 Nov 2022 13:52:38 +0100

In this video we will show a medialization thyroplasty under general anesthesia in a patient with a right recurrent laryngeal nerve paralysis after an oncologic surgery. The main steps for this procedure are: exposure of the thyroid cartilage, window creation (modified Montgomery technique), drilling of the window, internal perichondrium section, and finally, introduction of the Montgomery prosthesis.

Recurrent respiratory papillomatosis RRP

Tue, 17 Jan 2023 13:30:12 +0100

28 year old male patients with recurrence of the papillomatosis in anterior commissure. Recurrent respiratory papilllomatosis is the disease cause by HPV viruses typ 6/11. This disease is characterized by recurrent warts covering the epithelium. The patient was operated 6 months before in our Department. The papillomas were removed by using co2 laser. During the procedure the biopsy was taken to the histopathological examination. The lesions were excide only from the right vocal fold to prevent synechia and web formation in anterior commissure.

Pharyngoplasty

Sun, 11 Dec 2022 16:56:27 +0100

In this video we show the case of a patient with severe dysphagia due to an enlarged piriform sinus after a vocal cord paralysis. We performed a pharyngoplasty, resecting the excess of mucosa of the piriform sinus. We expose the thyroid cartilage, we cut the constrictor muscle, we cut the edge of the thyroid cartilage and we identify the mucosa of the piriform sinus. We cut the excess of mucosa with and Endo GIA stapler, and we then suture back the constrictor muscle, and we close by layers.

Pharyngeal reconstruction with pectoralis major myocutaneous flap

Sun, 11 Dec 2022 16:55:06 +0100

In this video we show a Fabian-type circular pharyngectomy closure with a split-thickness skin graft on the posterior wall and a horseshoe-shaped pectoralis major myocutaneous flap. In some cases where it is not possible to do a free flap, the pectoralis major flap with a split-thickness skin graft can be used to make a new pharynx. This video shows this technique. The split-thickness skin graft has been placed on the prevertebral wall, along with a salivary bypass tube. A pectoralis major myocutaneous flap is raised to close the pharynx. The skin of the pectoralis major myocutaneous flap is sutured to the esophagus at the lateral level. The proximal skin of the flap is sutured to the posterior wall of the theoretical pharynx, taking prevertebral muscles and the split-thickness skin graft. The flap is sutured at the base of the tongue. Finally, the remaining wall is sutured. It is reinforced by suturing the pectoralis muscle to the suprahyoid muscles.

Killian Jamieson Diverticulum Resection

Sun, 11 Dec 2022 13:18:20 +0100

In this video we show the resection of a KILLIAN-JAMIESON DIVERTICULUM, which is a diverticulum located lateral to the cervical esophagus due to its protrusion through a weak muscle area (Killian-Jamieson triangle). It is very rare, typically seen in patients over 50 years old, unilateral and at the left side. The etiology is controversial, but it is thought to be due to a lack of coordination. The most commonly (80% of cases) it is asymptomatic (typically detected in an US, and it is confused with a thyroid nodule). The symptomatic cases (20%) usually present dysphagia or cough. During surgery, the diverticulum is located on the left, in relation to the recurrent nerve. It is resected and in this case the constrictor muscle is sutured (myotomy is NOT performed).

Tracheostomy closure

Wed, 16 Nov 2022 13:46:50 +0100

In this video we will show a classic technique for sealing an old tracheostoma that did not close spontaneously.

It is usually a surgery performed under local anesthesia with or without sedation. It is generally divided into three layers: the skin around the tracheostomy, which will be the innermost layer, a layer of fat-fascia-muscle covering the previous suture, and finally, the skin.

There is usually no need to keep a drain after the surgery, and the results of the closure and the aesthetics are good.

Pectoralis Major Myocutaneous Flap

Sun, 11 Dec 2022 16:52:42 +0100

In this video we show how to raise a Pectoralis Major Myocutaneous Flap. An incision is made based on the size of the defect to reconstruct, the pectoralis major muscle is identified and, following the muscle, the flap is raised until the area is fully open, and we have exposed the entire area. The skin of the flap is fixed to the muscle to avoid breaking the perforating vessels. The rib is identified at the most distal end (in this case a small part of the anterior rectus muscle is removed) and the insertions of the pectoralis major muscle on the ribs are cut until the pectoralis minor muscle appears (where the insertions of the pectoralis major muscle end). The pedicle is seen through transparency just on the medial border of the pectoralis minor muscle. Once the pedicle is located, we continue cutting the pectoralis major muscle up to the clavicle and we elevate the flap to the neck.

Right neck dissection levels IIA, IIB, III and IV

Wed, 16 Nov 2022 14:00:22 +0100

In this video we show a neck dissection of the levels IIA, IIB, III and IV.

After cutting the skin, subplatismal flaps are raised. Then, the anterior border of the SCM muscle is identified and the fascia cut. The SCM muscle is skeletonized and the internal jugular vein is exposed. The XI cranial nerve (accessory nerve) is located in the upper third of the SCM muscle. The tissue above the nerve will also be removed in this procedure as the level IIB of the dissection. On the lower limit the omohyoid muscle is identified and preserved, but movilized to be able to remove the tissue below the muscle as the level IV of the dissection. The upper and lower ends of the internal jugular vein are identified and all the tissue on top of the vein is removed. The cervical rootlets are sought, preserved and followed, protecting the scalenes and the phrenic nerve at the floor of the neck.

External cordectomy approach

Sun, 11 Dec 2022 13:12:41 +0100

In this video we show the approach for an external cordectomy in a patient with glottic cancer. We start by exposing the thyroid cartilage, and we then proceed to cut it from the notch to the inferior border in a straight line in the midline using a saw. We are then able to visualize the glottis and the tumor from anterior to posterior.

Tumor of the right vocal fold. Cordectomy type II. SSTOLM

Tue, 17 Jan 2023 14:01:53 +0100

A 53-year-old man was admitted to the otolaryngology department due to hoarseness that had been present for several months. Stroboscopic examination revealed a tumor of the right vocal fold. The mobility of the fold was preserved, but the phonation vibrations of the right vocal fold were disturbed. Single stage transoral laser microsurgery was perform.
The epithelium and the subepithelial layer of the vocal fold were removed with the use of a CO2 laser. The specimen was sent for histopathological examination.

Vestibular fold cyst

Tue, 24 Jan 2023 11:39:37 +0100

This case shows the vestibular fold cyst in a 46-year-old woman diagnosed due to persistent voice disorders for several months. Vestibular fold cyst can be removed using cold still or CO2 laser. First, the epithelium of the vestibular fold was incised, exposing the cyst capsule, and then, using cold still, and CO2 laser the whole cyst was dissected.

Recurrent respiratory papillomatosis RRP

Tue, 24 Jan 2023 11:38:00 +0100

Recurrent respiratory papilllomatosis is the disease cause by HPV viruses typ 6/11. This disease is characterized by recurrent lesions covering the epithelium. This patients has been treated in our Department for 2 years. Last time 6 months ago. Endoscopic examination of the larynx revealed a large papilloma lesion located in the anterior commissure and in the anterior part of the right vocal fold. The papillomas were removed by using co2 laser. During the procedure the biopsy was taken to the histopathological examination. At the end of the procedure a starch dressing was used to prevent adhesions in the anterior commissure area.

Polyp of the right vocal fold

Tue, 17 Jan 2023 11:34:33 +0100

A patient with a right vocal fold polyp was admitted to the Department due to dysphonia.
The lesion was held with forceps and then removed with a CO2 laser scanner, power 2 watts.
When removing a polyp on a wide base, we try to maintain a healthy epithelium.

Second look cordectomy of the left vocal fold

Tue, 24 Jan 2023 11:40:37 +0100

This is a case showing second look operation in a patient who had a type II cordectomy performed 2 months earlier due to cancer of the left vocal fold reaching the anterior commissure.
Due to the positive superficial margin in the area of the anterior commissure and the close deep margin, the decision was made to perform a second look cordectomy.
Using a CO2 laser scanner, the power of 2 watts, the epithelium, subepithelial layer and part of the muscle were removed step by step. The specimen was sent for histopathological examination.