eLarynx

Lipofilling - Injection laryngoplasty

Sun, 11 Dec 2022 13:15:31 +0100

In this video we show an injection laryngoplasty after a type IV cordectomy. We did a lipofilling, where we inject the vocal cord with fat from the patient’s abdomen. We show the technique of grafting the fat, the preparation of it (centrifugation at 300rpm for 2 minutes) and the injection into the vocal cord.

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.

Montgomery T tube replacement

Sun, 11 Dec 2022 13:22:12 +0100

In this video we show the replacement of a Montgomery T tube in a patient with a tracheal stenosis. We remove the old tube, and we intubate the patient. We place a laryngoscope, and we explore the subglottis and trachea with an endoscope. We then ask the anesthesiologist to leave the patient in apnea and we remove the endotracheal tube and place the new Montgomery T tube. Next, we place a Fogarty catheter and we direct it upwards, we inflate the balloon so the anesthesiologist can ventilate the patient without air leak. As soon as the patient breathes spontaneously, the Fogarty is removed and the procedure is finished.

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.

Reinke's edema left vocal cord

Fri, 09 Dec 2022 13:18:54 +0100

49-year old female, Reinke´s edema of the left vocal cord, incision of the Reinke´s edema

Type I cordectomy with cold steal instruments

Sun, 11 Dec 2022 12:33:37 +0100

In this video we show the resection (excisional biopsy) using cold steal instruments in an old patient with comorbidities. We performed a limited type I cordectomy to get a final diagnosis. It combines assessment with endoscopes and with the microscope.

Arytenoid adduction

Sun, 11 Dec 2022 12:30:48 +0100

In this video we show an arytenoid adduction in a patient with a previous medialization thyroplasty. The thyroid cartilage is identified where the thyroplasty prosthesis placed 18 months ago is located. The posterior border of the thyroid cartilage is identified, and the constrictor muscle is cut. The mucosa of the piriform sinus is separated until the arytenoid is palpated. The muscular apophysis of the arytenoid is identified and this area is communicated with the paraglottic space where the prosthesis was (which is now removed). A suture is placed from the muscular apophysis to the anterior part of the thyroid cartilage, and the nod is used to adduct the arytenoid. Finally, a new medialization thyroplasty prosthesis is placed.

Cordectomy type III right vocal cord

Fri, 09 Dec 2022 12:47:16 +0100

69 year old, male, pT1a squamous cell carcinoma of the right vocal cord, cordectomy type III, laser

Recurrent respiratory papillomatosis RRP

Tue, 17 Jan 2023 13:07:02 +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 5 years. The papillomas are removed by using co2 laser.During the procedure the biopsy is taken to the histopathological examination. During the operation, the position of the endoscopic tube should be changed to make all lesions visible.

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 especially in anterior commissure. The second procedure is require after 6 -8 weeks.

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

Tumor of the left vocal fold. Cordectomy type V

Wed, 18 Jan 2023 10:55:58 +0100

A 68-year-old male was admitted to the otolaryngology department due to a tumor of the left vocal fold. T2 N0M0. Stroboscope examination showed a tumor infiltrating the entire left vocal fold, anterior commissure and penetrating to the subglottic area. In the computer tomography examination the infiltration of the laryngeal cartilages was not noticed. therefore, a decision was made to perform endoscopic surgery. Type V cordectomy was performed due to the extent of the tumor.
In the first stage of the operation, the left vestibular fold was removed to better visualize the lesion. Then, the soft tissues of the anterior commissure were separated from the thyroid cartilage using a CO2 laser and forceps. Step by step the entire vocal fold was removed, preserving the anatomical structures. During such an extensive resection, a monopolar electrode was used to coagulate bleeding vessels.

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.

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.

Biopsy of the left vocal cord

Fri, 09 Dec 2022 13:52:11 +0100

70-year old, male, dysplasia of the left vocal cord, cold steel resection

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.

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.

Bilateral cordotomy

Sun, 11 Dec 2022 12:53:26 +0100

In this video we show a laryngeal microsurgery where we performed bilateral cordotomy in a patient with bilateral vocal fold paralysis with significant dyspnea. We cut with laser both vocal folds on their posterior third and we immediately see how the airway gets significantly wider posteriorly, which will help the patient with the breathing problems.

6th European Laryngological Live Surgery Broadcast 2021

Tue, 18 Jan 2022 17:27:54 +0100

Project event E3

6th European Laryngological Live Surgery Broadcast 2021

2021-11-24

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.

Vestibular fold cyst

Tue, 17 Jan 2023 12:08:34 +0100

Vestibular fold cyst 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, exposing the cyst capsule, and then, using cold still, the cyst was dissected.

Total laryngectomy due to a non-functional larynx

Wed, 16 Nov 2022 13:22:22 +0100

In this video we will show a total laryngectomy due to a non-functional larynx. The patient had a history of treatment with chemoradiotherapy for a larynx cancer more than 10 years ago, and a hemiglossectomy, bilateral neck dissection and ALT free-flap reconstruction 5 years ago for a tongue cancer.

The current symptoms are: severe dysphagia with aspirations, and even after placing a PEG tube for feeding, the patient continued to have a pneumonia every month only due to aspiration of saliva.

The final decision was to perform a total laryngectomy. The neck was very fibrotic due to the previous treatments. Moreover, the patient had a granuloma at the anterior commissure for the past 3 years, which was non-tumoral.

We performed a separate incision from the tracheostomy, and we closed the pharynx with an endo GIA stapler.

Resection of eventration of mucosa of the ventricle

Sun, 11 Dec 2022 12:24:59 +0100

In this video we show a case of a patient with eventration of the mucosa of the ventricle, where we performed a laser resection.

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.

Supraglottic cancer TOUSS

Sun, 11 Dec 2022 17:02:51 +0100

In this video we perform a resection of a supraglottic cancer with transoral ultrasonic surgery (TOUSS). The cancer was in the laryngeal surface of the epiglottis. We start cutting at the level of the left aryepiglottic fold and then at the level of the right aryepiglottic fold and we proceed towards the base of the tongue. We circle the entire epiglottis, and we removed the whole tumor with sufficient margins.

Polyp resection left vocal cord

Fri, 09 Dec 2022 12:32:21 +0100

64-year-old patient, polyp of the right vocal cord, resection of the polyp cold steel