eLarynx

Left vocal fold paralysis. Injection laryngoplasty. Fat supplementation.

Tue, 24 Jan 2023 11:35:34 +0100

A 32-year-old woman, a mathematics teacher, was admitted to the Otolaryngoplogy Department because of hoarseness that had persisted for several months. 8 months earlier, she underwent surgery to remove the thyroid gland due to its enlargement. Stroboscopic examination showed complete paralysis of the left vocal fold. The patient was qualified for surgery to supplement the left vocal fold with fat. Fat was collected from the abdominal

T1 supraglottic carcinoma

Fri, 09 Dec 2022 13:41:47 +0100

70 year old, male, T1 suraglottic squamous cell carcinoma, transoral tumor resection using Medrobotics Flex® Robotic System

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.

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.

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.

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.

Cordectomy type III of the left vocal cord

Fri, 09 Dec 2022 12:21:34 +0100

65-year old, male, pT1 squamous cell carcinoma of the left vocal cord, Laser cordectomy type III

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.

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.

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.

Hemorrhagic polyp of the right vocal fold

Tue, 17 Jan 2023 11:51:31 +0100

A female patient was admitted to the department due to sever dysphonia. Stroboscopic examination revealed a huge hemorrhagic polyp of the right vocal fold.
The CO2 laser was used in the initial stage of the operation, then, due to massive bleeding, microsurgical scissors were used to remove the polyp. At the end of the procedure, excess mucosa was also removed with scissors

Total laryngectomy with Endo GIA closure

Sun, 11 Dec 2022 13:10:13 +0100

In this video we show a total laryngectomy performed with the surgeon on the left side in a patient with a T4a larynx cancer. A left hemithyroidectomy was also performed as part of the oncologic surgery. The closure was done using an Endo GIA.

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.

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.

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.

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

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.

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

Epiglottic cyst

Fri, 09 Dec 2022 13:38:46 +0100

54-year-old, male, epiglottic cyst, resection of the cyst using Medrobotics Flex® Robotic System

7th European Laryngological Live Surgery Broadcast 2022

Fri, 02 Dec 2022 15:05:51 +0100

Project event E2

7th European Laryngological Live Surgery Broadcast 2022

2022-11-23

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.

Vallecula cyst

Fri, 09 Dec 2022 13:53:54 +0100

67-year-old, female, vallecular cyst, cyst excision with laser

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

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

5th European Laryngological Live Surgery Broadcast 2019

Tue, 01 Sep 2020 09:21:06 +0200

Project event E1

5th European Laryngological Live Surgery Broadcast 2019

2019-11-27