eLarynx

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

Recurrent respiratory papillomatosis RRP

Tue, 17 Jan 2023 12:51:56 +0100

This is a case of a patient with laryngeal papillomatosis. The disease was diagnosed 7 years ago. During this time, he underwent 8 procedures to remove papillomas. This time the lesions are located in the posterior commissure and on both arytenoids. The CO2 laser was used to removed the papillomas by vaporization. During the operation, the position of the endoscopic tube should be changed to make all lesions visible.

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).

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.

Bogdasarian type I posterior glottic stenosis surgery

Sun, 11 Dec 2022 12:57:17 +0100

In this video we will show a patient with a Bogdasarian type I posterior glottic stenosis (interarytenoid scar with normal posterior commissure). We performed a microlaryngoscopy surgery with cold steal, cutting the scar tissue and injecting steroids afterwards.

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.

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.

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.

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.

Subepithelial cordectomy right vocal cord

Fri, 09 Dec 2022 13:30:29 +0100

48-year old, male, cyst of the right vocal cord, cordectomy type I (subepithelial) right side

T2 hypopharyngeal carcinoma

Fri, 09 Dec 2022 13:50:51 +0100

65-year-old, male, T1 suraglottic squamous cell carcinoma, transoral tumorresection using Medrobotics Flex® Robotic System

Vallecula cyst

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

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

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.

Vallecula cyst resection

Fri, 09 Dec 2022 13:35:42 +0100

72-year old, female, vallecular cysts, resection of vallecular cysts with laser

Total laryngectomy due to a non-functional larynx

Wed, 16 Nov 2022 13:22:22 +0100

In this video we will show a total laryngectomy due to a non-functional larynx. The patient had a history of treatment with chemoradiotherapy for a larynx cancer more than 10 years ago, and a hemiglossectomy, bilateral neck dissection and ALT free-flap reconstruction 5 years ago for a tongue cancer.

The current symptoms are: severe dysphagia with aspirations, and even after placing a PEG tube for feeding, the patient continued to have a pneumonia every month only due to aspiration of saliva.

The final decision was to perform a total laryngectomy. The neck was very fibrotic due to the previous treatments. Moreover, the patient had a granuloma at the anterior commissure for the past 3 years, which was non-tumoral.

We performed a separate incision from the tracheostomy, and we closed the pharynx with an endo GIA stapler.

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 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.

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.

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.

Reinke's edema left vocal cord

Fri, 09 Dec 2022 13:18:54 +0100

49-year old female, Reinke´s edema of the left vocal cord, incision of the Reinke´s edema

Vestibular fold cyst

Tue, 24 Jan 2023 11:39:37 +0100

This case shows the vestibular fold cyst in a 46-year-old woman diagnosed due to persistent voice disorders for several months. Vestibular fold cyst can be removed using cold still or CO2 laser. First, the epithelium of the vestibular fold was incised, exposing the cyst capsule, and then, using cold still, and CO2 laser the whole cyst was dissected.

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.

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.

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.

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.