eLarynx

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.

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.

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).

Laryngeal papillomatosis vaporized with blue laser

Sun, 11 Dec 2022 12:55:18 +0100

In this video we show a patient with recurrent papillomatosis of the larynx, operated multiple times, who in this case is operated using the blue laser to better reach the lesion, which is located posteriorly, at the level of the vocal process of the right arytenoid. The result was very good.

T1 supraglottic carcinoma

Fri, 09 Dec 2022 13:41:47 +0100

70 year old, male, T1 suraglottic squamous cell carcinoma, transoral tumor resection 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

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

Posterior cordotomy due to glottic stenosis

Fri, 09 Dec 2022 12:27:41 +0100

64-year old, female, bilateral vocal cord paralysis, posterior cordotomy (Kashima) with laser

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.

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.

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.

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

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.

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.

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.

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)

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.

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.

Injection laryngoplasty for sulcus vergeture

Sun, 11 Dec 2022 12:13:21 +0100

In this video we show a case of sulcus vergeture of the vocal folds. We performed an injection laryngoplasty with fat in both vocal folds. We see the immediate result, observing how the vocal folds get bulkier.

Hemorrhagic polyp of the left vocal fold

Tue, 24 Jan 2023 09:41:16 +0100

A young patient was admitted to the clinic because of dysphonia. Stroboscopic examination revealed a hemorrhagic polyp of the left vocal fold. The lesion was removed using a CO2 laser scan, power 2-3 watts. Slight bleeding occurred during the procedure. The bleeding vessel was coagulated using a laser.

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

Endoscopic marsupialization of a Zenker´s diverticulum

Wed, 16 Nov 2022 11:54:03 +0100

In this video, we show the marsupialization of a Zenker´s diverticulum through an endoscopic approach using CO2 laser. We start by introducing the endoscope until we localize the diverticulum. We then cut the crycopharyngeal muscle with laser, which is the origin of the problem. As soon as the muscle ends, we stop cutting due to the risk of a fistula.

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.

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.

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.