Category: Surgical video - eLarynx

Tumor of the right vocal fold. Cordectomy type II

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

A 63-year-old male was admitted to the otolaryngology department due to a tumor of the right vocal fold. Stroboscopic examination showed a tumor infiltrating the upper and medial surfaces of the right vocal fold, the tumor did not reach the anterior commissure or the subglottic region. The mobility of the right vocal fold was preserved, only limited phonation vibrations were found. Based on stroboscopy and NBI, a decision was made to completely remove the lesion without prior biopsy. 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 epithelium and subepithelial layer were removed, preserving the remaining anatomical structures of the vocal fold.
The specimen was sent for histopathological examination.

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.

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.

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.

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.

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.

Resection of vallecular cyst

Fri, 09 Dec 2022 12:42:41 +0100

50 year-old, female, vallecular cyst, resection of the cyst with cold steel

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.

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)

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

Reinke's edema resection cold steel

Fri, 09 Dec 2022 13:28:56 +0100

53-year old, female, Reinke’s edema, excision of the Reinke’s edema left side

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.

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

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.

Resection of a intubation granuloma

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

26-year old female, polyp of the posterior vocal cord after prior intubation 6 months ago, excision of the polyp with cold steel

Resection of a chondroma of the thyroid cartilage

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

In this video we show how to resect a chondroma of the thyroid cartilage. The larynx and the thyroid cartilage are exposed. The constrictor muscle is sectioned. The cartilage is rotated and exposed to see the tumor on the external side. The cartilage is sectioned with a saw anterior to where the tumor is located. The tumor is separated from the piriform sinus and the paraglottic space. The inferior horn of the thyroid is disarticulated. Finally, the tumor is removed. The constrictor muscle is sutured to the infrahyoid muscles. A drain is left, and we close by layers.

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.

Polyp of the left vocal cord

Fri, 09 Dec 2022 13:24:05 +0100

57 year old, female, polyp of the left vocal cord, polyp resection with laser

Cordectomy IV right vocal cord

Fri, 09 Dec 2022 12:37:45 +0100

53-year old, male, rpT2 cN0 M0 squamous cell carcinoma of the right larynx, cordectomy type IV, failed prior treatment with radiotherapy (67,5Gy)

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.

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.

Left neck dissection levels II-III-IV

Sun, 11 Dec 2022 12:40:03 +0100

In this video we show a patient affected with larynx cancer (cT4aN2bM0). In this first part of the recording we present the left neck dissection. We performed the neck dissection for levels IIa, also IIb (at the end), III and IV. The possible presence of the thoracic duct stands out.

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.

Polyp of the posterior vocal cord

Fri, 09 Dec 2022 13:25:44 +0100

49 year old, male, polyp posterior vocal cord, polyp resection, laser

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.