eLarynx

Tumor of the left vocal fold. Cordectomy type III

Tue, 17 Jan 2023 14:26:52 +0100

A 65-year-old man was admitted to the otolaryngology department due to recurrence of left vocal fold cancer. Eight months earlier, a type I chordectomy of the left vocal fold was performed due to carcionoma in situ. Stroboscopic examination revealed a tumor covering the anterior 2/3 of the vocal fold and a complete disturbance of phonation vibrations. Due to the penetration of the tumor into the subepithelial layer and infiltration of the vocalis muscle, a type III cordectomy was performed. Using the CO2 laser the pathology can be excised step by step respecting the anatomical layers. Finally the carcinoma can be removed and sent for histopathological examination.

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 13:20:39 +0100

A young patient was admitted to the clinic because of sever dysphonia. The symptoms such as hoarseness had occurred 3 months earlier and had gradually worsened since then. Recently, there has been a deterioration in physical performance and slight shortness of breath while running. Stroboscopic examination revealed a huge number of papilloma like warts covering both vocal folds, vestibular folds, extended to the subglottic region.

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.

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.

Cordectomy type I left vocal cord

Fri, 09 Dec 2022 13:34:02 +0100

56-year old, female, leukoplakia left vocal cord, cordectomy type I

Type I cordectomy and previous assessment without endotracheal tube

Sun, 11 Dec 2022 13:01:45 +0100

In this video, an assessment with endoscope while the patient is in apnea is performed prior to intubation to thoroughly explore the larynx. This is a patient with a leukoplakia (final pathology: severe dysplasia). Once the endoscopy has been performed, which allows for a very accurate assessment of the larynx, the patient is intubated and direct laryngoscopy is performed. We start the direct laryngoscopy using the endoscope again, to move on to a type I cordectomy with CO2 laser and microscope. Once the cordectomy is finished, the endoscope is used again to better visualize the resection.

T2 hypopharyngeal carcinoma

Fri, 09 Dec 2022 13:50:51 +0100

65-year-old, male, T1 suraglottic squamous cell carcinoma, transoral tumorresection using Medrobotics Flex® Robotic System

Left vocal fold paralysis. Injection laryngoplasty. Fat supplementation.

Tue, 24 Jan 2023 11:35:34 +0100

A 32-year-old woman, a mathematics teacher, was admitted to the Otolaryngoplogy Department because of hoarseness that had persisted for several months. 8 months earlier, she underwent surgery to remove the thyroid gland due to its enlargement. Stroboscopic examination showed complete paralysis of the left vocal fold. The patient was qualified for surgery to supplement the left vocal fold with fat. Fat was collected from the abdominal

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.

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.

Right neck dissection levels IIA, III and IV in the context of a salvage total laryngectomy

Wed, 16 Nov 2022 13:57:01 +0100

In this video we show a neck dissection of the ipsilateral levels IIA, III and IV in the context of an N0 laryngeal cancer that it is undergoing a salvage total laryngectomy.

Different incisions can be done, but in this case we used the same incision we later used for the total laryngectomy, which it is a separate incision from the tracheostomy.

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. On the lower limit the omohyoid muscle is identified. 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.

Leukoplakia of the right vocal fold. Cordectomy type I

Tue, 17 Jan 2023 12:38:16 +0100

This case shows the leukoplakia of the right vocal fold. Cordectomy typ I was performed to excise the lesion. Cotton swab was used to secure the intubation tube. In the first stage, using a laser, we mark the resection margin, then we remove only the epithelium of the vocal fold, preserving the deeper layers, such as the vocal ligament or the vocal muscle.

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.

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.

Wharton Duct Clipping for drooling

Sun, 11 Dec 2022 17:07:25 +0100

In this video we show a procedure to improve one of the common dysphagia problems, which is drooling. We performed a ligation with clips of the Wharton’s duct (we show one side, but it is done bilaterally). The papilla is located, an incision is made in the floor of the mouth, the Wharton’s duct is identified, and confirmed with sialoendoscopy material by placing the guide inside Wharton’s duct. Once well isolated, 2-3 clips are placed, and the mucosa that was opened in the floor of the mouth is closed.

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.

Posterior glottic stenosis (Bogdasarian type I)

Sun, 11 Dec 2022 17:01:18 +0100

In this video we show a surgery for a posterior glottic stenosis (Bogdasarian type I). During the surgery, the scarred area is located (a fusion between the vocal processes of the arytenoids), and it is cut with scissors. Subsequently, steroids are injected throughout the region. The result was excellent, recovering normal motility and normal laryngeal function.

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

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

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.

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.

Recurrent respiratory papillomatosis RRP

Tue, 17 Jan 2023 12:51:56 +0100

This is a case of a patient with laryngeal papillomatosis. The disease was diagnosed 7 years ago. During this time, he underwent 8 procedures to remove papillomas. This time the lesions are located in the posterior commissure and on both arytenoids. The CO2 laser was used to removed the papillomas by vaporization. During the operation, the position of the endoscopic tube should be changed to make all lesions visible.

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.

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.