Angled Endoscopes Research Articles

Endoscope-Assisted Middle Fossa Approach: Optimizing the Surgical Corridor for the Resection of Multicompartmental Chordomas.

Background Skull base chordomas are a major therapeutic challenge. The surgical management involves selecting an approach that will offer the patient the best chance of largest/complete removal while minimizing morbidity and mortality. Methods Medical records and imaging review of two skull base chordomas involving the middle fossa and posterior fossa that were successfully treated with an endoscope-assisted middle fossa approach. Results The use of angled endoscopes provided better identification of anatomical landmarks and improved tumor resection when compared with the microscopic surgical exposure. The approach selection, anatomical landmarks, and technical aspects of the intraoperative setting of the endoscope-assisted approach are discussed. Conclusion Endoscopic assistance in the middle fossa approach is a safe and valuable tool for maximizing the reach of the surgical corridor when treating skull base chordomas.

Supracerebellar Infratentorial Endoscopy for Quadrigeminal Cistern Epidermoid

The standard microscopic supracerebellar infratentorial approach for the pineal region is limited by tunnel vision. Herein, we describe endoscopic supracerebellar infratentorial surgery in a patient with quadrigeminal cistern epidermoid presenting with hydrocephalus. In the sitting position, following a 6 cm longitudinal incision and small suboccipital craniotomy, the dura was cut in V shape and kept reflected. The bridging veins were coagulated and cut, taking the 0° endoscope inside. A sharp incision is given over the thickened arachnoid over the inferior paramedian area. The precentral cerebellar vein is exposed at the lower part, coagulated and divided. Gentle bimanual intracapsular removal of the epidermoid flakes is performed with intermittent saline irrigation and suction. Assisted by rotating the angled endoscope, curved coaxial instruments help remove the cerebello-mesencephalic and lateral extensions of the epidermoid. Endoscopic supracerebellar infratentorial approach provides a panoramic and angled view of the pineal region, through a narrow corridor, avoiding cerebellar retraction.

Chordoma of the Craniocervical Junction: Endoscopic Endonasal Approach.

Objective This study was aimed to achieve gross-total removal of a chordoma of the craniocervical junction via an endonasal approach ( Fig. 1 ). Fig. 1 Pre- and postoperative images of the craniocervical junction chordoma. ( A ) It shows a preoperative sagittal T2-weighted MRI image. ( B ) It shows a preoperative axial T2-weighted MRI image. Note that a T2-hyperintense lesion is located in the lower clivus and the odontoid. ( C ) It shows the postoperative sagittal T1-weighted gadolinium enhanced MRI image. ( D ) shows a postoperative axial T2-weighted MRI image. These images show the fat graft used for closure, but no evident tumor remnant. MRI, magnetic resonance imaging Design The present study is a case report. Setting The study was conducted at neurosurgical clinic of university hospital. Participant A 40-year-old male, with normal neurologic exam and no prior medical history, presented with a 2-year history of cervicalgia. On preoperative imaging, a midline lesion, with image characteristics of chordoma, was seen in the lower clivus and odontoid. It had limited lateral extension. Main Outcome Measures This study measures postoperative neurological deficits and postoperative tumor volume on magnetic resonance imaging (MRI). Results A binostril approach to the upper nasopharynx was performed using endoscope at 30- and 45-degree angles. Subsequently, a heart-shaped mucosal flap was made and the clivus was drilled to expose the lesion ( Fig. 2 ). After initial debulking, the ring of C1 was slightly drilled to reach the tumor in and around the odontoid. Postoperative MRI showed that a gross-total resection was achieved. The patient had no neurologic deficits postoperatively. Pathologic examination revealed a chordoma of the classical type. Fig. 2 Illustration of the endoscopic endonasal surgical technique. ( A ) It shows the surgical route (blue arrow), and location of the heart-shaped mucosal flap that was made in the upper nasopharynx (blue crescent). This figure highlights that angled endoscopes are needed to visualize the relevant operative field (yellow translucent triangle). ( B ) shows the axial view, ( C ) shows an intraoperative endoscopic view of the incision performed to achieve a heart-shaped mucosal flap, as was utilized during this case, and ( D ) shows the coronal view. ( B and D ) They show the results of postoperative image analysis, during which we segmented the drill cavity (in blue) and projected it on the preoperative CT scan of the patient. Note that besides the inferior clivus, the superior part of the ring of C1 was also drilled slightly to reach the tumor in the odontoid. CT, computed tomography. Conclusion An endoscopic endonasal approach, utilizing the heart-shaped flap and angled endoscopes and instruments, can be considered for resection of select cases of craniocervical junction chordoma with limited lateral expansion. The link to the video can be found at: https://youtu.be/rwVoZJRBIEo .

Endoscopic-assisted surgical repair of superior canal dehiscence using a keyhole middle fossa craniotomy approach

Superior canal dehiscence (SCD) is a bony defect of the superior semicircular canal that is called SCD syndrome (SCDS) when associated with vestibular and auditory dysfunction. Surgical management of SCD is reserved for patients with intractable auditory and/or vestibular symptoms. As direct visualization of an arcuate eminence defect is most easily achieved from above, the majority of cases use a microscope-assisted middle fossa craniotomy. However, approximately 30% of SCD cases have a medial arcuate eminence defect along a downsloping tegmen. These defects can be difficult to visualize without a large cranial window, drilling down a prominent lateral skull base ridge, and/or prolonged brain retraction. In line with recent development of endoscopic ear surgery, the endoscope has been employed at our institution via a middle fossa craniotomy approach to repair a SCD. We believe that skull base endoscopy is a safe and effective way to identify and repair a medial or blue-lined SCD when used with a middle fossa craniotomy approach. The angled endoscope enhances visualization and transillumination of the SCD and reduces temporal lobe retraction. The following chapter highlights an endoscopic-assisted middle fossa craniotomy repair of SCD.

Endoscopic-assisted rib cartilage harvesting for revision rhinoplasty

We describe the endoscopic-assisted rib harvesting technique for secondary rhinoplasty as minimum - invasive and safe harvesting method. Endoscopic-assisted rib harvesting was performed on 52 patients for revision rhinoplasty in last two years (2017-2019). Adequate amount of cartilage was obtained through 1-2 cm incision. The 30 degrees angled endoscope was used for vision control. Fifty-two patients underwent rhinoplasty with costal cartilage harvested using endoscopic-assisted method. The length of the harvested cartilage blocks from the rib was 5 ± 1.5 cm in average. There were no associated intraoperative complications. Postoperative complications were less than by the conventional rib harvesting technique: in all cases, no signs of pneumothorax or excessive bleeding were detected after surgery. The wound healed without significant scarring in 50 (96%) cases. Two patients (4%) showed hypertrophic scar formation. Postoperative pain was evaluated by using Visual Pain Analog Scale retrospectively. Forty-eight patients (92%) scored 1.43 ± 0.7 experienced no significant postoperative pain. Only 4 patients (8%) scored 4.1 ± 0.8 and complained of slight postoperative pain. This technique provides an effective and less-invasive alternative for conventional costal cartilage harvesting with reduced complications risk and extended visualization. Patients benefit from an inconspicuous scar and reduced postoperative pain. Technique can be applied for revision and primary rhinoplasty and allows achieving reproducible aesthetically and functionally successful results with minimized risks.

Extent of maxillary sinus surgery and its effect on instrument access, irrigation penetration, and disease clearance.

Middle meatal antrostomy (MMA) provides limited access to the anteromedial and inferior aspect of the maxillary sinus (MS) often resulting in residual disease and inflammatory burden. Newer extended procedures, such as mega-antrostomy (Mega-A) and extended modified mega-antrostomy (EMMA), have been developed to address this limitation. This study assesses the effect of varying extent of MS surgery on irrigation penetration and access of instrumentation. The MS of 5 fresh-frozen cadavers were sequentially dissected. Irrigation was evaluated with a squeeze bottle (SB) in different head positions and using different volumes of fluid. Surgical reach and visualization were examined using common sinus instruments and different angled endoscopes. A disease simulation was also performed to check for residual debris after instrumentation and irrigations. Irrigation penetration improved as antrostomy size increased (p < 0.0001), with a significant difference observed between the extended procedures and MMA. The effect of the volume was significant for SB (p < 0.0001) but head positions appeared irrelevant (p = 0.613). Overall visualization improved for Mega-A and EMMA. A similar trend was seen for the reach of the instruments to all sinus wall subsites. EMMA facilitated the most removal of "sinus disease" in the disease simulation model when compared with both MMA and Mega-A, due to its reach of the anteroinferior aspects of the maxillary sinus. High-volume irrigation using SB achieved good sinus penetration, irrespective of head position. Extended MS procedures appear to further increase irrigation penetration as well as surgical access.

Symptom: Dizziness with Ear Pressure

Symptom: Dizziness with Ear Pressure

Development and evaluation of a patient-specific surgical simulator for endoscopic colloid cyst resection.

Endoscopic resection of third-ventricle colloid cysts is technically challenging due to the limited dexterity and visualization provided by neuroendoscopic instruments. Extensive training and experience are required to master the learning curve. To improve the education of neurosurgical trainees in this procedure, a synthetic surgical simulator was developed and its realism, procedural content, and utility as a training instrument were evaluated. The simulator was developed based on the neuroimaging (axial noncontrast CT and T1-weighted gadolinium-enhanced MRI) of an 8-year-old patient with a colloid cyst and hydrocephalus. Image segmentation, computer-aided design, rapid prototyping (3D printing), and silicone molding techniques were used to produce models of the skull, brain, ventricles, and colloid cyst. The cyst was filled with a viscous fluid and secured to the roof of the third ventricle. The choroid plexus and intraventricular veins were also included. Twenty-four neurosurgical trainees performed a simulated colloid cyst resection using a 30° angled endoscope, neuroendoscopic instruments, and image guidance. Using a 19-item feedback survey (5-point Likert scales), participants evaluated the simulator across 5 domains: anatomy, instrument handling, procedural content, perceived realism, and confidence and comfort level. Participants found the simulator's anatomy to be highly realistic (mean 4.34 ± 0.63 [SD]) and appreciated the use of actual instruments (mean 4.38 ± 0.58). The procedural content was also rated highly (mean 4.28 ± 0.77); however, the perceived realism was rated slightly lower (mean 4.08 ± 0.63). Participants reported greater confidence in their ability to perform an endoscopic colloid cyst resection after using the simulator (mean 4.45 ± 0.68). Twenty-three participants (95.8%) indicated that they would use the simulator for additional training. Recommendations were made to develop complex case scenarios for experienced trainees (normal-sized ventricles, choroid plexus adherent to cyst wall, bleeding scenarios) and incorporate advanced instrumentation such as side-cutting aspiration devices. A patient-specific synthetic surgical simulator for training residents and fellows in endoscopic colloid cyst resection was successfully developed. The simulator's anatomy, instrument handling, and procedural content were found to be realistic. The simulator may serve as a valuable educational tool to learn the critical steps of endoscopic colloid cyst resection, develop a detailed understanding of intraventricular anatomy, and gain proficiency with bimanual neuroendoscopic techniques.

Endoscopic Visualization of the True Maxillary Ostium Following Uncinectomy.

To examine the frequency in which angled endoscopes are necessary to visualize the true maxillary ostium (TMO) following uncinectomy and prior to maxillary antrostomy. Additionally, to identify preoperative computed tomography (CT) measures that predict need for an angled endoscope to visualize the TMO. Retrospective study. Tertiary academic hospital. Patients who underwent endoscopic sinus surgery (ESS) between December of 2017 and August of 2018 were retrospectively identified. Cases were reviewed if they were primary ESS cases for chronic rhinosinusitis without polyposis and if they were at least 18 years of age. Sixty-three maxillary antrostomies were reviewed (82.5% were from bilateral cases). Thirty-five cases (55.6%) required an angled endoscope in order to visualize the TMO. Of the preoperative CT measures examined, a smaller sphenoid keel-caudal septum-nasolacrimal duct (SK-CS-NL) angle was significantly associated with need for an angled endoscope intraoperatively to visualize the TMO (17.1° SD ± 3.2 vs 15.0° SD ± 2.9; P = .010). Angled endoscopes are likely required in the majority of maxillary antrostomies to visualize the TMO. This is important to recognize in order to prevent iatrogenic recirculation. The SK-CS-NL angle may help to identify cases preoperatively which require an angled endoscope to identify the TMO during surgery.

Clinical application of endoscope combined with microscope for the microvascular decompression in hemifacial spasm

Objective: To evaluate the effectiveness and safety of the endoscope combined with microscope for the microvascular decompression in hemifacial spasm. Methods: A total of 26 patients underwent endoscope combined with microscopic facial nerve microvascular decompression through retrolabyrinthine approach from January 2013 to December 2016 were retrospectively reviewed in Ear Institute, Shanghai Jiaotong University School of Medicine. Among them, 9 were male and 17 were female, with a mean age of (51.9±11.4) years;15 cases of left side and 11 of right side patients were followed up for 1-3 years. The pre-and post-operative Cohen Classification was used for hemifacial spasm, House-Brackmann Grade for facial nerve function, hearing level and complication rates were reviewed. SPSS 19.0 software was used to analyze the data. Results: All 26 patients were operated successfully. No recurrence was seen during 1-3 year follow-up. Post-operative Cohen Grade were as follows: 25 cases with Cohen Grade I and 1 case with Cohen Grade II. The difference in Cohen grade between pre-and post-operative was statistically significant (Z=-4.87, P<0.01). Post-operative facial nerve function was satisfactory in all patients (House-Brackmann Grade I-II in all patients). No hearing loss was observed. No facial paralysis and other lower cranial nerve dysfunction were observed. No postoperative complications such as cerebrospinal fluid leakage occurred. Conclusions: Using an angled endoscope combined with microscope in microvascular decompression in hemifacial spasmis is safe and effective.

Endoscopic classification of the external auditory canal for transcanal endoscopic ear surgery

ObjectiveEvaluation of an endoscopic anatomic classification of the external auditory canal (EAC) for transcanal endoscopic ear surgery. Materials and methodThe EAC Canal Endoscopic Scale (CES) was initially defined according to total or partial EAC narrowing on 0° transcanal endoscopy. A retrospective study was then conducted between September 2013 and March 2015 in a series of consecutive patients fulfilling the study inclusion criteria. ResultsA total of 83% of 5000 patients (10000 ears) were classified as CES 0: i.e., total visualization of the tympanic membrane. Various kinds of EAC narrowing were described. Results were comparable between right and left ears. Conclusions0° endoscopy provided total visualization of the tympanic membrane in most cases, thanks to its magnified lateral view. Preoperative CES classification allows use of angled endoscopes, curved instruments or drilling for canalplasty to be planned in the first step of transcanal endoscopic ear surgery.

Posterior Approach to Meckel's Cave: Retrosigmoid Craniectomy with Endoscopic Assistance.

Background Meckel's cave involvement in tumors pose a challenge due to their surrounding neurovascular structure and deep location. Case Review A 24-year-old male presented with progressive headaches and right sided trigeminal neuralgia with a large epidermoid. The tumor extended from the ambient cistern to the cerebellomedullary cistern and involved Meckel's cave ( Fig. 1 ). Technical Note/Video Description A retrosigmoid craniectomy was performed. Cranial nerves 3, 4, 6, 7, and 10, and auditory brainstem responses were monitored. Once the craniectomy was completed the dura was opened and cerebrospinal fluid (CSF) was released from the cisterna magna to allow for the tumor resection to be done without the use of any retractors ( Fig. 2 ). Care was taken to ensure that cranial nerves in the posterior fossa were detethered to prevent any traction injury. Using ring curettes the pearly white epidermoid tumor was able to be debulked. After all the possible tumor was resected with the microscope, the 30-degree endoscope was used to identify the porus trigeminus. Malleable ring curettes and a malleable suction were used to remove the soft tumor from this location. The patient transiently had loss of hearing but this returned within 2 weeks after surgery. Conclusions The retrosigmoid approach is familiar to all neurosurgeons and with the adjunct of an angled endoscope, the posterior Meckel's cave can be easily reached. This is particularly useful for tumors with soft consistency. The assistance of the endoscope allows Meckel's cave visualization without additional drilling while still allowing safe resection of tumor from around the trigeminal nerve. The link to the video can be found at: https://youtu.be/01aqOyUmSW0 .

Endoscope-Assisted Minimally Invasive Microsurgical Removal of a Medium-Sized Acoustic Neuroma (T3a) through a Retrosigmoid Mini-Craniotomy with Preservation of Hearing.

A 45-year-old male patient with reduced hearing in the right ear was diagnosed with a medium-sized (T3a) acoustic neuroma. The operation was performed through an individually tailored retrosigmoid mini-craniotomy. Endoscope-assisted microsurgical technique was applied to early detect the location of the facial and cochlear nerves as well as to look around the hidden corners during the surgery. The entire operation was performed without using brain retractors. The moderate intrameatal extension of the tumor and the use of angled endoscopes allowed to avoid the drilling of the internal auditory meatus. The lesion could be completely removed and the patient showed a satisfactory hearing recovery in the follow-up examinations 3 months after the surgery. The link to the video can be found at: https://youtu.be/dAYLakih924 .

Endoscope-assisted excision of recurrent frontotemporal dermoid: A case report

Craniofacial dermoids develop as a result of sequestration of epidermal and adnexal components within mesodermal and neuroectodermal structures during embryonic development. Frontotemporal dermoids are the most common of these and usually present as slow-growing masses without discharging sinus or deep bone or intracranial extension. We present a case of recurrent frontotemporal dermoid with discharging sinus and invasion into the sphenoid bone with bone erosion and intracranial extradural extension of dermoid. The patient was managed with surgical excision and clearance of dermoid. Complete surgical excision was ensured with the help of angled nasal endoscopes. Endoscopes provide a wide angle of view and are available in various angles, hence helping in complete visualization of bony cavity and clearance of its contents. The use of endoscopes in surgeries of craniofacial dermoids can help in reducing chances of residual lesion and requirement of subsequent revision surgery and ensure a better cosmesis.

Surgical outcome in chronic otitis media with cholesteatoma

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Cholesteatoma is synonymous with active squamous type of disease where there is retraction of pars flaccida or tensa that has retained squamous epithelial debris and is associated with inflammation and the production of pus. This pathology can only be eradicated by meticulous surgery. Our study compares the surgical outcome of intact canal wall vs. canal wall down surgeries done for cholesteatoma.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective study on 42 patients who underwent surgery for cholesteatoma between December 2010 and March 2013 at VIMS, Bellary. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The net improvement in ABG in ICW mastoidectomy was 16.03 (±7.5) dB and that in CWD mastoidectomy was 11.39(±7.4) dB with a significant p value of 0.04 as determined by the independent ‘t’ test. The residual disease rate for ICW mastoidectomy was determined as 12% whereas recurrence rate was nil. CWD mastoidectomy had no residual or recurrent disease in the 6-month follow-up period. Postoperative complications were noted in 15% of the study population.&lt;/p&gt;&lt;p class="ETDBodyText"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The ICW and CWD surgeries have their own advantages and disadvantages and when performed meticulously both serve the purpose of rendering the patient a safe ear. The ICW procedure leaves behind an anatomically near normal ear and when quality of life concerns needs to be addressed this should be the procedure of choice, with advancement in technology and availability of angled endoscopes which have marched well into otology. The CWD procedure should be reserved to cases presenting with complications and in patients who are more likely to be lost to follow-up.&lt;/p&gt;

Clinical and cost utility of an intraoperative endoscopic second look in cholesteatoma surgery.

This study aimed to determine the clinical and cost-effectiveness of endoscopes during cholesteatoma surgery. More specifically, this study hypothesized that endoscope use would reduce cholesteatoma recurrence rates and cost. Case series involving the prospective enrollment of 110 consecutive cholesteatoma patients over a 2-year period. Patients underwent cholesteatoma surgery with microscopy. During dissection, the location of the cholesteatoma was assessed. At the end of dissection and before reconstruction, the same subunits were visualized with straight and angled endoscopes for residual cholesteatoma. Hearing was analyzed before surgery and at the last possible examination. Costs were analyzed using Medicare reimbursement rates from the Centers for Medicare and Medicaid Services. Intraoperative endoscopic surveillance was able to detect residual cholesteatoma in 18 patients. With a 0° endoscope, residual cholesteatoma was noted in the epitympanum (two patients), sinus tympani (one patient), and the supratubal air cells (one patient). With a 45° endoscope, residual cholesteatoma was noted in the epitympanum (three patients), sinus tympani (nine patients), the supratubal air cells (two patients), and the mesotympanum (two patients). From a cost analysis, endoscopic surveillance ($6110.36 per patient) are less expensive than second look surgeries ($11,829.83 per patient), observation ($7097.20 per patient), and observation with annual magnetic resonance imaging studies ($9891.95 per patient). The patients hearing improved after surgery, consistent with previous studies. No complications were noted from the use of endoscopes. Intraoperative endoscopic surveillance reduced recurrence in our series of 110 patients. Endoscopes are particularly useful in evaluating the epitympanum, mesotympanum, sinus tympani, and supratubal air cells. Moreover, endoscopic surveillance is cost-effective. 4 Laryngoscope, 128:2867-2871, 2018.

Endoscopic Assisted Retrosigmoid Approach for Cerebellopontine Angle Epidermoid Tumor.

This case is a 20-year-old male, who presented with 1 month of right facial weakness (HB4) and complaints of ipsilateral eye dryness. He was initially treated for Bell's palsy with steroids and antiviral agents, but subsequently developed diplopia with right lateral gaze and underwent an MRI (magnetic resonance imaging). MRI demonstrated a 4.5 cm irregular lesion in the right cerebellopontine angle consistent with an epidermoid cyst. Because the tumor had grown with the development of the central nervous system, it has extended into different compartments, including the tentorial incisura and pineal region. A predefined surgical corridor created by the tumor facilitated access to the majority of the tumor through a retrosigmoid approach. Angled endoscopes (30-degree up and down) provided further visualization of tumor away from the line of sight of the microscope, thus allowing for gross total resection of the lesion. This video also demonstrates a sharp dissection technique necessary for safe removal of adherent tumor from critical neurovascular structures, including the basilar artery and several cranial nerves. The ipsilateral auditory evoked responses (ABRs) showed slight improvement from baseline toward the end of the case. A gross total resection was achieved, as shown by the MRI. The patient remained at his baseline cranial nerve (CN) V, VII, and VIII deficits during the immediate postoperative period. The link to the video can be found at: https://youtu.be/vCq5juJh8hk .

Chronic otitis media with cholesteatoma: clinical presentation and surgical management

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Cholesteatoma has long been a formidable adversary to the otologic surgeon. There is no single surgical treatment of choice for aural cholesteatoma. The extent of cholesteatoma, the amount of preoperative destruction, and mastoid pneumatization, guides the surgeon in choosing the type of operation for a particular ear. Intra-operative findings guide the surgeon to perform the required surgery despite thorough pre-operative work-up.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective study on 42 patients who underwent surgery for cholesteatoma. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Cholesteatoma most commonly affected males aged between 10-20 years. Also, the disease was noted to be more aggressive in the paediatric age group. Foul smelling ear discharge was the most common presenting symptom followed by hearing loss. 21% of patients presented with complications. Canal wall down mastoidectomy was done in patients with complications and in cases where adequate disease clearance could not be accomplished with the posterior canal wall intact. All patients in the study underwent ossicular reconstruction. This was owing to either the destruction of ossicles by the disease process or to achieve adequate disease clearance.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Disease eradication is still the main aim of the surgery, but, when it can be achieved keeping the posterior canal wall intact, the canal wall should always be left intact. With advances in technology and availability of angled endoscopes this should be given more consideration. However, in a patient with complications and patients who are not available for regular follow-up the canal wall down surgery is preferred.&lt;/p&gt;

Management of Difficult Laryngeal Exposure During Suspension Microlaryngoscopy.

Difficult laryngeal exposure during suspension microlaryngoscopic surgeries is a common situation encountered by the phonosurgeons nowadays. It leads to unnecessary trauma, incomplete surgery and even abortion of the procedure. Although various methods have been described to counter the situation, they might not be adequate in some cases with very anteriorly placed larynx. This study is intended to determine the utility of angled rigid endoscope along with malleable endoscopic instruments to improve surgical access in cases with inadequate glottic exposure during suspension microlaryngoscopy. In this cross sectional study conducted at Lokmanya Tilak Municipal Medical College and General Hospital in Mumbai, 50 patients of voice disorders who underwent Suspension Microlaryngoscopy from July 2014 to December 2017 were included. Out of these patients, 5 patients (10%) presented with difficult laryngeal exposure that were operated using readily available angled rigid endoscope along with malleable endoscopic instruments, without requirement of any specially designed instruments. There was improvement in laryngeal exposure in all the cases following utilisation of angled endoscopes. The surgeries were carried out under video monitor guidance with complete excision of the vocal cord lesions. Our study concluded that the cases in which the laryngeal exposure cannot be improved even by various external procedures, can be enhanced by application of angled rigid endoscopes and the vocal cord lesions can be excised completely by using malleable endoscopic instruments.

Clinical observation of radiofrequency coblation therapy in early glottis cancer involving the anterior commissure with endoscope

Objective: To explore clinical effect of CO₂ laser combined with radiofrequency coblation therapy on early glottis carcinoma involving the anterior commissure with endoscope.Method:The clinical data of 10 patients with early glottis cancer involving the anterior commissure who were underwent CO₂ laser and radiofrequency coblation with angled endoscope was retrospective analyzed.All patients receieved CT scan with contrast to rule out the cases with thyroid cartilage plate involvement.Result:The surgeries were performed successfully on all of the 10 patients. The pathology of the 10 patients were all squamous cell carcinoma. Surgical margins showed no residual tumor cell. There was no recurrence or metastasis with a follow-up of 6 to 48 months.Conclusion:It was an effective treatment for the CO₂ laser and radiofrequency coblation therapy in glottis cancer involving the anterior commissure with endoscope.