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.

Recurrent respiratory papillomatosis RRP

Tue, 17 Jan 2023 13:07:02 +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 5 years. The papillomas are removed by using co2 laser.During the procedure the biopsy is taken to the histopathological examination. During the operation, the position of the endoscopic tube should be changed to make all lesions visible.

The papillomas were removed by using co2 laser. During the procedure the biopsy was taken to the histopathological examination. The lesions were excide only from the right vocal fold to prevent synechia and web formation especially in anterior commissure. The second procedure is require after 6 -8 weeks.

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.

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

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.

Injection laryngoplasty for sulcus vergeture

Sun, 11 Dec 2022 12:13:21 +0100

In this video we show a case of sulcus vergeture of the vocal folds. We performed an injection laryngoplasty with fat in both vocal folds. We see the immediate result, observing how the vocal folds get bulkier.

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.

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)

Recurrent respiratory papillomatosis

Fri, 09 Dec 2022 13:48:48 +0100

61-year old, male, recurrent respiratory papillomatosis (RRP), laserresection of papillomatosis

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.

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.

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.

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.

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.

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

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

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

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

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

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

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.

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

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

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.