eLarynx

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.

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.

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.

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.

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.

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

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

Tumor of the right vocal fold. Cordectomy type V

Tue, 17 Jan 2023 14:42:03 +0100

A 72-year-old male was admitted to the otolaryngology department due to a tumor of the right vocal fold. T2 N0M0. Histopathological examination showed squamous cell carcinoma. In the computer tomography examination the infiltration of the laryngeal cartilages was not noticed, therefore it was possible to perform endoscopic surgery with the use of the C02 laser. Type 5 cordectomy was performed due to the extent of the tumor. The tumor involved the entire vocal fold, the anterior commissure and the anterior part of the left vocal fold.
In the first stage of the operation, the right vestibular fold was removed to better visualize the lesion. Then, the soft tissues of the anterior commissure were separated from the thyroid cartilage. Step by step, using a laser, the entire vocal fold was removed, preserving the anatomical structures.

Tumor of the left vocal fold. Cordectomy type II

Tue, 17 Jan 2023 14:09:25 +0100

A 56-year-old woman was admitted to the otolaryngology department due to a tumor of the left vocal fold. The patient was smoking 20 cigarettes per day for over 30 years. 3 weeks earlier, a biopsywas taken, which showed the neoplastic nature of the lesion. 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 specimen was sent for histopathological examination.

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.

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.

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.

Supraglottic cancer TOUSS

Sun, 11 Dec 2022 17:02:51 +0100

In this video we perform a resection of a supraglottic cancer with transoral ultrasonic surgery (TOUSS). The cancer was in the laryngeal surface of the epiglottis. We start cutting at the level of the left aryepiglottic fold and then at the level of the right aryepiglottic fold and we proceed towards the base of the tongue. We circle the entire epiglottis, and we removed the whole tumor with sufficient margins.

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.

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).

Vestibular fold cyst

Tue, 17 Jan 2023 12:08:34 +0100

Vestibular fold cyst 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, exposing the cyst capsule, and then, using cold still, the cyst was dissected.

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.

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.

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.

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.

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

Limited type I cordectomy for dysplasia

Sun, 11 Dec 2022 13:20:13 +0100

In this video we show a very limited resection in a relatively small lesion. The final pathology reported moderate dysplasia. Endoscopic assessment and then type I cordectomy are shown.

Tumor of the left vocal fold. Cordectomy type II

Tue, 17 Jan 2023 13:51:54 +0100

A 61-year-old man was admitted to the otolaryngology department due to cancer of the left vocal fold. Cordectomy type II was performed.
In the first stage, the resection margin was marked, and then the epithelium and subepithelial layer together with Reinke's space were removed. The specimen was sent for histopathological examination.

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)

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.