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.

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.

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.

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.

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

Vallecula cyst

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

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

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

Cordectomy IV right vocal cord

Fri, 09 Dec 2022 12:37:45 +0100

53-year old, male, rpT2 cN0 M0 squamous cell carcinoma of the right larynx, cordectomy type IV, failed prior treatment with radiotherapy (67,5Gy)

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.

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.

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.

Type I cordectomy with cold steal instruments

Sun, 11 Dec 2022 12:33:37 +0100

In this video we show the resection (excisional biopsy) using cold steal instruments in an old patient with comorbidities. We performed a limited type I cordectomy to get a final diagnosis. It combines assessment with endoscopes and with the microscope.

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.

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

Polyp of the left vocal fold

Tue, 17 Jan 2023 11:14:29 +0100

A patient with a left vocal fold polyp was admitted to the Department due to dysphonia.
Cotton swab was used to secure the endotracheal tube. A CO2 laser was used to remove the lesion. Material was taken with forceps for histopathological examination.
The most important thing is to keep as much healthy epithelium as possible when removing the polyp

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

Dilation of a subglottic stenosis in a patient with tracheostomy

Wed, 16 Nov 2022 13:49:48 +0100

In this video we are showing a dilation of a subglottic stenosis in a patient with tracheostomy. In this case, it was a membranous stenosis that we treated with balloon dilation after we cut with cold steel the stenosis. We repeated 3 dilations of 1 minute each, and we ended the procedure injecting corticosteroids into the stenotic area.

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.

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

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

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.

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

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.

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.

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