eLarynx

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.

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.

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.

Recurrent respiratory papillomatosis RRP

Tue, 24 Jan 2023 11:38:00 +0100

Recurrent respiratory papilllomatosis is the disease cause by HPV viruses typ 6/11. This disease is characterized by recurrent lesions covering the epithelium. This patients has been treated in our Department for 2 years. Last time 6 months ago. Endoscopic examination of the larynx revealed a large papilloma lesion located in the anterior commissure and in the anterior part of the right vocal fold. The papillomas were removed by using co2 laser. During the procedure the biopsy was taken to the histopathological examination. At the end of the procedure a starch dressing was used to prevent adhesions in the anterior commissure area.

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

Tumor of the right vocal fold. Cordectomy type II. SSTOLM

Tue, 17 Jan 2023 14:01:53 +0100

A 53-year-old man was admitted to the otolaryngology department due to hoarseness that had been present for several months. Stroboscopic examination revealed a tumor of the right vocal fold. The mobility of the fold was preserved, but the phonation vibrations of the right vocal fold were disturbed. Single stage transoral laser microsurgery was perform.
The epithelium and the subepithelial layer of the vocal fold were removed with the use of a CO2 laser. The specimen was sent for histopathological examination.

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.

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.

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.

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.

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 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

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 vallecular cyst

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

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

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.

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.

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.

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.

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.

Polyp of the right vocal fold

Tue, 17 Jan 2023 11:34:33 +0100

A patient with a right vocal fold polyp was admitted to the Department due to dysphonia.
The lesion was held with forceps and then removed with a CO2 laser scanner, power 2 watts.
When removing a polyp on a wide base, we try to maintain a healthy epithelium.

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

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).

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.

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

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.