Channel: Chapter 8 - Laryngeal stenosis and other surgeries - eLarynx

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

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.

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.

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.

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.

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 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.

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.

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.

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.

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.

Dilation of a subglottic stenosis in a patient with tracheostomy

Wed, 16 Nov 2022 13:49:48 +0100

In this video we are showing a dilation of a subglottic stenosis in a patient with tracheostomy. In this case, it was a membranous stenosis that we treated with balloon dilation after we cut with cold steel the stenosis. We repeated 3 dilations of 1 minute each, and we ended the procedure injecting corticosteroids into the stenotic area.

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.

Mucosal bridge in the right vocal fold

Sun, 11 Dec 2022 13:23:30 +0100

In this laryngeal microsurgery, a typical mucosal bridge is shown in a 23-year-old patient with chronic dysphonia. In this case the bridge is located and resected. In this patient, during the same surgery, lipofilling was performed on the vocal fold afterwards (not shown in the video).

Bogdasarian type I posterior glottic stenosis surgery

Sun, 11 Dec 2022 12:57:17 +0100

In this video we will show a patient with a Bogdasarian type I posterior glottic stenosis (interarytenoid scar with normal posterior commissure). We performed a microlaryngoscopy surgery with cold steal, cutting the scar tissue and injecting steroids afterwards.

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)

Dilation of an idiopathic subglottic stenosis

Wed, 16 Nov 2022 11:12:44 +0100

In this video we are showing a dilation of an idiopathic subglottic stenosis in a 80 years-old woman. We start using a laryngoscope, to first inject corticosteroids into the stenosis. After that, we cut the scar with cold steel and we then proceed with the balloon dilation, with a 15mm balloon. To do the balloon dilation we leave the patient in apnea and we remove the endotracheal tube. After a minute, we intubate again and we re-start ventilation. We repeat this as many times as needed. The results of this case were excellent.

Plasmacytoma resection

Sun, 11 Dec 2022 16:59:40 +0100

In this video, we will show the resection of a plasmacytoma of the pre-epiglottic space. We start by detaching the infrahyoid muscles from the hyoid bone. We expose the cranial edge of the thyroid cartilage, and we continue to dissect above it until we find the mass. We carefully remove the mass with bipolar cautery and blunt dissection. We had to remove a part of the thyroid cartilage to have a better exposure of the lesion. Once completely removed, we closed by layers.