eLarynx

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.

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.

Tumor of the left vocal fold. Cordectomy type V

Wed, 18 Jan 2023 10:55:58 +0100

A 68-year-old male was admitted to the otolaryngology department due to a tumor of the left vocal fold. T2 N0M0. Stroboscope examination showed a tumor infiltrating the entire left vocal fold, anterior commissure and penetrating to the subglottic area. In the computer tomography examination the infiltration of the laryngeal cartilages was not noticed. therefore, a decision was made to perform endoscopic surgery. Type V cordectomy was performed due to the extent of the tumor.
In the first stage of the operation, the left vestibular fold was removed to better visualize the lesion. Then, the soft tissues of the anterior commissure were separated from the thyroid cartilage using a CO2 laser and forceps. Step by step the entire vocal fold was removed, preserving the anatomical structures. During such an extensive resection, a monopolar electrode was used to coagulate bleeding vessels.

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.

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.

Vallecula cyst

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

67-year-old, female, vallecular cyst, cyst excision 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.

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.

Recurrent respiratory papillomatosis RRP

Tue, 17 Jan 2023 13:20:39 +0100

A young patient was admitted to the clinic because of sever dysphonia. The symptoms such as hoarseness had occurred 3 months earlier and had gradually worsened since then. Recently, there has been a deterioration in physical performance and slight shortness of breath while running. Stroboscopic examination revealed a huge number of papilloma like warts covering both vocal folds, vestibular folds, extended to the subglottic region.

Recurrent respiratory papillomatosis RRP

Tue, 17 Jan 2023 13:40:49 +0100

60 year old female patients with RRP.
A 60-year-old woman, a teacher of Polish literature, suffering from recurrent papillomatosis of the larynx for several years. The stroboscopy revealed a lesion on the laryngeal surface of the epiglottis. Due to the difficult location, the lesion was removed using a microdebrider with a suction function. During the procedure, the epiglottis was held with forceps.

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.

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.

Cordectomy type II left vocal carcinoma

Fri, 09 Dec 2022 13:08:06 +0100

52-year old, male, pTis verrucous carcinoma of the left vocal cord, multiple drug abuse and infectious diseases, cordectomy II with laser

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 and previous assessment without endotracheal tube

Sun, 11 Dec 2022 13:01:45 +0100

In this video, an assessment with endoscope while the patient is in apnea is performed prior to intubation to thoroughly explore the larynx. This is a patient with a leukoplakia (final pathology: severe dysplasia). Once the endoscopy has been performed, which allows for a very accurate assessment of the larynx, the patient is intubated and direct laryngoscopy is performed. We start the direct laryngoscopy using the endoscope again, to move on to a type I cordectomy with CO2 laser and microscope. Once the cordectomy is finished, the endoscope is used again to better visualize the resection.

Polyp of the right vocal fold

Tue, 17 Jan 2023 11:41:02 +0100

This is a case of a patient with a polyp located in a posterior part of the right vocal fold. The lesion was held with forceps and then removed with a CO2 laser with scanner mode

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

Tumor of the right vocal fold. Cordectomy type II

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

A 63-year-old male was admitted to the otolaryngology department due to a tumor of the right vocal fold. Stroboscopic examination showed a tumor infiltrating the upper and medial surfaces of the right vocal fold, the tumor did not reach the anterior commissure or the subglottic region. The mobility of the right vocal fold was preserved, only limited phonation vibrations were found. Based on stroboscopy and NBI, a decision was made to completely remove the lesion without prior biopsy. 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 epithelium and subepithelial layer were removed, preserving the remaining anatomical structures of the vocal fold.
The specimen was sent for histopathological examination.

Tumor of the left vocal fold. Leucoplakia. Cordectomy type I/II

Tue, 24 Jan 2023 11:36:44 +0100

This case shows the small tumor of the middle part of the left vocal fold. In the stroboscopic examination, the mobility of the fold was preserved and the vibrations were slightly limited in the middle part. Cordectomy typ I partial typ II 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 the epithelium but in some parts also subepithelial layer of the vocal fold, preserving the deeper layers, such as the vocal ligament or the vocal muscle. The specimen was sent for histopathological examination.

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

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.

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.

Zenker's diverticulum

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

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

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.