eLarynx

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

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.

Leukoplakia right vocal cord

Fri, 09 Dec 2022 13:22:38 +0100

72 year old, male, leukoplakia of the right vocal cord, cordectomy I, laser

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.

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.

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.

Papilloma resection right vocal cord

Fri, 09 Dec 2022 13:55:08 +0100

70-year old, male, recurrent respiratory papillomatosis (RRP), laser resection of papillomatosis

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.

Zenker's diverticulum

Fri, 09 Dec 2022 13:37:21 +0100

84-year-old, female, Zenker’s divertikulum, transoral, combined divertikulum surgery

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.

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 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)

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.

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.

Laryngeal papillomatosis with dysplasia

Sun, 11 Dec 2022 12:15:23 +0100

In this video we show a bilateral type I cordectomy without resecting the anterior commissure, using infiltration with local anesthetic in the space of Reinke and cold instruments. A very thin endotracheal tube is used (technique with a special respirator) to facilitate the exposure of the entire glottis. We use a combination of endoscopes and microscope.

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.

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

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.

Cordectomy type V

Fri, 09 Dec 2022 13:21:07 +0100

55 year-old, pT1b squamous cell carcinoma of the left glottis, laser cordectomy type V

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.

Subepithelial cordectomy right vocal cord

Fri, 09 Dec 2022 13:30:29 +0100

48-year old, male, cyst of the right vocal cord, cordectomy type I (subepithelial) right side

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.

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.

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.

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.