Direct Microlaryngoscopy Research Articles

National Trends in Laryngeal Laser Surgery: Comparison of Operative Versus Office-Based Procedures.

To analyze national trends in the prevalence of office-based laryngeal ablative procedures and compare those with traditional operative excisional procedures utilizing direct laryngoscopy. For years 2013-2022, the US Medicare Part B claims database was searched for Current Procedural Terminology (CPT) codes 31572 (flexible laryngoscopy with laser ablation of lesion), 31540 (operative direct laryngoscopy with excision of lesion), 31541 (operative direct microlaryngoscopy with excision of lesion), and 31545 (operative direct microlaryngoscopy with excision of lesion and local tissue flap reconstruction). For each CPT code, the total number of charges billed to the Medicare database in each calendar year was recorded and annual trends were analyzed. Biopsy procedures were not included. The annual number of office-based laser procedures (CPT 31572) remained relatively constant since the CPT code was introduced in 2017 (range: 18887-25241 procedures annually, trendline slope = +16, R2:0.02). Office-based laser procedures comprised a small portion of total laryngeal excisional procedures (range: 8.4%-12.1%). The total number of operative laryngeal excisions, billed by CPT 31540 and 31541, declined over the studied time frame (Trendline slope = -132, R2:0.93; Trendline slope = -950, R2: 0.93 respectively). Office-based laser procedures comprise a small fraction of procedures to remove laryngeal lesions. The number of office-based laser procedures has been relatively stable over the last 5 years. This finding contrasts with the prevailing health care trend toward office-based procedures. Further research is needed to understand the decrease in operative laryngeal lesion excision procedures observed over the last 10 years. 4 Laryngoscope, 2024.

Direct Microlaryngoscopy and Excision of Vocal Cord Lesion

In this case, Dr. Brown and Dr. Cohen perform a direct microlaryngoscopy and excise a vocal cord lesion.

Predominantly unilateral laryngomalacia in infants with unilateral vocal fold paralysis

BackgroundNeonatal unilateral vocal fold paralysis may arise iatrogenically, idiopathically, or in the context of an underlying neurologic disorder. Management is often supportive, focusing on diet modification to allow for safe oral feeding. We describe the clinical course of six infants with unilateral vocal fold paralysis who developed predominantly unilateral laryngomalacia ipsilateral to the affected vocal fold with associated severe respiratory symptoms and feeding difficulty. MethodsRetrospective review of six infants with unilateral vocal fold paralysis and predominantly unilateral laryngomalacia. Charts were reviewed for etiology of vocal fold paralysis, presenting symptoms, operative details, postoperative course, and outcomes for breathing and swallowing. ResultsEtiology of vocal fold paralysis included cardiac surgery in four patients, intubation-related in one, and idiopathic in one. Presenting symptoms included increased work of breathing, stridor, feeding difficulty, respiratory failure requiring noninvasive respiratory support, and weak cry. All infants were on nasogastric tube feedings. Direct microlaryngoscopy with unilateral or predominantly unilateral (conservative contralateral aryepiglottic fold division) supraglottoplasty was performed. Stridor and work of breathing improved in all six patients within 1 week postoperatively. Oral feeding improved in three patients within 2 weeks. Three patients had persistent feeding impairment with improvement within one year. ConclusionsPredominantly unilateral laryngomalacia may arise in the context of unilateral vocal fold paralysis. Addressing the ipsilateral cuneiform collapse can improve breathing and feeding. This may be an under-described phenomenon and represents an additional reason to include the otolaryngologist early in the care of infants with suspected possible new unilateral vocal fold paralysis. Breathing and swallow can improve post-operatively, but feeding may remain limited by the vocal fold paralysis and any medical comorbidities. Ongoing follow-up and collaboration with speech-language pathology to optimize feeding are important.

Efficacy of cidofovir versus bevacizumab in recurrent respiratory papillomatosis: A randomized, double-blind, placebo-controlled pilot study

ObjectivesAfter surgical resection of papilloma, adjuvant therapy may be recommended for the control of recurrent respiratory papillomatosis (RRP). As the efficacy of adjuvant therapy remains unproven, the aim of this study was to compare the efficacy of cidofovir versus bevacizumab used as adjuvant therapies for the control of RRP. MethodsThis randomized, double-blind, placebo-controlled pilot study was performed in a national respiratory disease referral centre. Patients with RRP were recruited prospectively and were divided into juvenile or adult RRP. Participants were randomly assigned to receive adjuvant therapy with cidofovir, bevacizumab or placebo. The study drug or placebo was administered after direct microlaryngoscopy with papilloma resection using cold instruments. The Derkay severity score and the Voice Handicap Index (VHI) were assessed at 3–6-week intervals, for a total of 3 visits. Follow-up included VHI and Derkay score assessments at 2-month intervals over the course of one year. Annual rates before and after surgical treatment were compared. ResultsFive children and 11 adults were enrolled in the study. After one year, the group treated with cidofovir had a significant decrease in Derkay score (p=.027). No difference between treatment arms was observed in the annual surgery rate. There was a significant decrease in the VHI score in all treatment groups (p<.001), and no significant difference was observed between groups (p=.32). ConclusionWhile we observed a significant decrease in RRP severity with intralesional cidofovir, we were unable to provide proof of efficacy of intralesional bevacizumab.Clinicaltrials.gov Identifier: NCT02555800.

Voice Handicap Index Changes After Microflap Surgery for Benign Vocal Fold Lesions Are Not Associated With Recommended Absolute Voice Rest Duration.

Voice rest is frequently prescribed after phonosurgery, but optimal type and duration for voice outcomes have not been demonstrated. Studies to date have been characterized by heterogeneity in surgical procedures and laryngeal diagnoses. We sought to analyze the effect of recommended absolute voice rest duration on outcomes of microflap surgery for benign vocal fold lesions. A secondary purpose was to identify patient factors associated with postoperative voice outcomes. Forty-three patients were included in this retrospective review of patients aged 18 years and above who underwent direct microlaryngoscopy with microflap for vocal fold polyp or cyst over a 5-year period at a multidisciplinary voice center. Duration of recommended postoperative absolute voice rest was classified as less than 7 days, 7 days, and more than 7 days. Demographic and vocal hygiene data and voice treatment history were collected. Outcome measures consisted of one pre- and two postoperative Voice Handicap Index (VHI) scores. Effects of recommended voice rest on outcomes were analyzed using mixed models for repeated measures. Effects of patient factors on outcomes were analyzed as exploratory measures. Stroboscopy ratings were analyzed descriptively. Thirteen patients were recommended 7 days of absolute voice rest, 15 were recommended less than 7 days, and 15 were recommended more than 7 days. Postoperatively, VHI scores significantly improved for all patients. Voice rest as a continuous variable was associated with the Functional subscale score in the short term, but there was no effect on VHI total score and no longer term effect of voice rest on any outcome. Age, sex, and preoperative voice therapy were associated with at least one VHI subscale score on at least one time point. VHI outcomes of microflap surgery for polyps and cysts do not differ by duration of recommended absolute postoperative voice rest. https://doi.org/10.23641/asha.19178459.

Endolaryngeal surgery of benign vocal fold lesions with a 445 nm semiconductor laser: postoperative management

Introduction. Today the high prevalence of benign vocal fold lesions is shown (up to 55-70%). The possibilities of surgical management of this pathology are very extensive. Laser technologies are becoming more and more popular among high-tech treatment methods. However the comprehensive postoperative management of these patients is equally important.The aim of the study was to assess the features of the postoperative period in patients undergoing the endolaryngeal surgery using a semiconductor laser with a wavelength of 445 nm.Material and methods. On the basis of Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech from February to June 2021 20 patients with benign vocal fold lesions 6 women and 14 men from 24 to 67 years old were examined and treated. All the patients underwent endolaryngeal surgery with direct microlaryngoscopy using a new semiconductor 445 nm laser in an inert gas atmosphere (intraoperative helium supply). After surgical treatment, the patients observed vocal rest, received antiinflammatory, antibacterial therapy, inhalations, as well as the drug Homeovox® according to the standard scheme.Conclusion. Endolaryngeal surgery with the removing of benign vocal fold lesions using a semiconductor laser with a wavelength of 445 nm has been proven to be safe and effective. According to the results of video laryngostroboscopy, acoustic analysis of the voice (the questionnaire “Voice handicap index-30”) it was noted that the laryngeal functions were restored in a short time. The inclusion of Homeovox® in the complex postoperative treatment had a favorable effect on the restoration of the phonatory function.

Efficacy of cidofovir versus bevacizumab in recurrent respiratory papillomatosis: A randomized, double-blind, placebo-controlled pilot study

ObjectivesAfter surgical resection of papilloma, adjuvant therapy may be recommended for the control of recurrent respiratory papillomatosis (RRP). As the efficacy of adjuvant therapy remains unproven, the aim of this study was to compare the efficacy of cidofovir versus bevacizumab used as adjuvant therapies for the control of RRP. MethodsThis randomized, double-blind, placebo-controlled pilot study was performed in a national respiratory disease referral centre. Patients with RRP were recruited prospectively and were divided into juvenile or adult RRP. Participants were randomly assigned to receive adjuvant therapy with cidofovir, bevacizumab or placebo. The study drug or placebo was administered after direct microlaryngoscopy with papilloma resection using cold instruments. The Derkay severity score and the Voice Handicap Index (VHI) were assessed at 3–6-week intervals, for a total of 3 visits. Follow-up included VHI and Derkay score assessments at 2-month intervals over the course of one year. Annual rates before and after surgical treatment were compared. ResultsFive children and 11 adults were enrolled in the study. After one year, the group treated with cidofovir had a significant decrease in Derkay score (p=.027). No difference between treatment arms was observed in the annual surgery rate. There was a significant decrease in the VHI score in all treatment groups (p<.001), and no significant difference was observed between groups (p=.32). ConclusionWhile we observed a significant decrease in RRP severity with intralesional cidofovir, we were unable to provide proof of efficacy of intralesional bevacizumab.Clinicaltrials.gov Identifier: NCT02555800.

Resident's preparedness for independent practice following Otorhinolaryngology-Head and Neck Surgery residency program: a cross-sectional survey.

Evaluate perception of preparedness for independent practice following the Otorhinolaryngology-Head and Neck Surgery residency program of Université de Montréal. Cross-sectional survey of graduates from the past 10years. Participants were asked about their level of confidence at the end of their residency for various procedures using a 5-point Likert scale. 7 out of 27 procedures were mastered by most physicians at the end of residency. The highest confidence level was in head and neck surgery (4 out of 5 procedures with a mean confidence level of 4 or higher) and lowest in laryngology and otology (both having 3 procedures with a median confidence level of 2 or less). The lowest confidence level was seen in ossiculoplasty and thyroplasty, being the only procedures to have a mean confidence level below 2. The highest scores were seen in superficial parotidectomy, direct microlaryngoscopy and trans-oral drainage of an abscess. These latter were the only procedures in which 100% of the respondent had a confidence level of 4 or 5. It has recently been suspected that these fields were potential weaknesses, so adjustments were made. This study provides new information to improves the curriculum. Recent and incoming change's impact on resident's confidence will be assessed in the future. This study highlights procedures and Otorhinolaryngology-Head and Neck Surgery subspecialties in which more surgical exposure or curriculum changes could increase resident's confidence and skills as part of a comprehensive Otorhinolaryngology practice.

Clinical-pathological characterization of laryngeal cancer in the Mexican population

Cancer of the larynx occupies the first frequency site of cancer of the upper digestive tract and represents 42% of malignant neoplasms of the upper aero-digestive tract. It is a potentially curable entity if it is diagnosed in early stages. Characterize the clinical pathological features of patients with laryngeal cancer, which can serve as a guide for diagnostic suspicion in primary and secondary care. Descriptive study. All the records of patients with an initial diagnosis of primary laryngeal carcinoma undergoing direct micro-laryngoscopy plus biopsy from January 1, 2014 to December 31, 2018 were analyzed. 173 new cases of laryngeal carcinoma were diagnosed, the male sex predominated (86%). With an average age of presentation of 65 ± 11 years and a history of smoking in 78.6% (n 136). Dysphonia was the initial symptom in 81% (140) of the patients. The profile of the patient with laryngeal cancer corresponds to a patient older than 60 years, male, a history of smoking and a history of dysphonia greater than 30 days. Clinically, we will find an epithelial epidermoid moderately differentiated tumor limited to the glottis.

Five-year results of vocal fold augmentation using autologous fat or calcium hydroxylapatite.

To evaluate 5-year voice outcomes of vocal fold augmentation (VFA) using autologous fat (AF) injection via direct microlaryngoscopy versus office-based calcium hydroxylapatite (CaHA) injection. Retrospective study of patients who underwent VFA between 2012 and 2015, with a 5-year follow-up. Patients with a glottic gap of ≤ 3mm caused by unilateral vocal fold paralysis or vocal fold atrophy were included in the study. VFA was performed using AF injection via direct microlaryngoscopy in 17 patients, and using office-based CaHA injection in 19 patients. Subjective satisfaction with voice, voice handicap index (VHI), and maximal phonation time (MPT) were analyzed pre-injection, and at 12 and 60months post-VFA. Altogether 36 patients underwent VFA between 2012 and 2015, of whom 5 were excluded within 1year post-VFA, and 2 were excluded between 1 and 5years post-VFA. Of the remaining 29 patients, 3 (10.3%) underwent re-intervention at between 1 and 3years post-VFA. Thus, the 5-year follow-up included 26 patients (72.2%; 11 males and 15 females). At 5years after surgery, 73.1% of the patients were satisfied with their voice, with no significant between-group difference (P=0.307). The mean improvement of VHI was 28.8±17.82 in the autologous fat group versus 33±26.24 in the CaHA group (P=0.458). MPT improvement was also similar between the two groups: 6.2±4.26 for the autologous fat group versus 6.3±4.34 for the CaHA group (P=0.667). Both AF injection via direct microlaryngoscopy and office-based CaHA injection yielded good and comparable 5-year results.

Force effects on anatomical structures in transoral surgery − videolaryngoscopic prototype vs. conventional direct microlaryngoscopy

Abstract Direct microlaryngoscopy is a frequently performed procedure in otorhinolaryngology, whereby considerable force is exerted on the patients’ teeth, as well as oropharyngeal and laryngeal structures. Especially in cases of a challenging exposure of the anterior commissure, the cervical spine needs to be brought into a hyperextended position, which is not possible in every patient. Therefore, the conflict between the straight rigid microlaryngoscope and the curvature of the oropharyngeal corridor frequently results in tissue trauma with the consequence of teeth fracture, hematoma or nerve injury. We have developed the s-MAC system, a hyper-angulated video laryngoscope with flexible instruments for transoral laryngeal surgery, which so far shows high feasibility in preclinical studies. Due to its curved shape it may exert less force on teeth and supraglottis as conventional direct microlaryngoscopy. We quantified the effects of these two surgical systems using flexible pressure sensors in two different scenarios: a mobile, hyperextended and an immobile cervical spine of the dummy, to simulate a challenging airway. We could demonstrate a 21% (40% with immobilized cervical spine) reduction of the average peak force acting on the maxillary incisors and a 55% (65% with immobilized cervical spine) reduction of the average intraoperative force on the supraglottis. The developed prototype applied therefore significantly less force on upper front teeth and supraglottis as compared to conventional direct microlaryngoscopy – especially in the case of an immobilized cervical spine.

Is Continued Perioperative Antithrombotic Therapy Safe When Performing Direct Microlaryngoscopy?

To evaluate whether antithrombotic status impacts the incidence of perioperative or postoperative bleeding in direct microlaryngoscopy (DML). Retrospective chart review. Patients undergoing DML in a single surgeon's practice from September 2012 to September 2017 were studied. Included patients underwent DML with or without biopsy, balloon dilation, microsurgery, laser ablation, or vocal fold injection. Patients were stratified based on perioperative antithrombotic status and assessed for rates of peri- and postoperative bleeding and other complications. Of the 581 patients meeting inclusion criteria, 179 patients (31%) had a history of baseline antithrombotic therapy. Of these patients, 124 had perioperative continuation of their therapy. Medicated patients were older (P < .01), predominately male (P < .01), and increasingly comorbid (P < .01). Perioperative complications unrelated to bleeding occurred in 22 patients (4%), minor perioperative bleeding occurred in four patients (0.7%), and minor postoperative bleeding occurred in 12 of the 479 patients with recorded follow-up (2.5%). There were no postoperative bleeds requiring intervention or readmission, and no recorded thrombotic events during the peri- and postoperative period. There was no difference in perioperative bleeding based on baseline antithrombotic status (P = .81). Patients on baseline antithrombotic therapy were more likely to have a postoperative bleed in comparison to patients without history of antithrombotic use (P < .01). However, there were no significant differences in postoperative bleeding between patients on baseline anticoagulation who continued or ceased their medication perioperatively (P = .45). Perioperative continuation of antithrombotic medications appears to be safe when performing routine DML. 4 Laryngoscope, 2020.

Management of Vocal Fold Scars by Concurrent Nanofat and Microfat Grafting.

Vocal fold scarring is the cause of severe dysphonia and represents a therapeutic challenge; dysphagia can also be present in case of soft tissue defect due to previous oncological surgery. The ideal surgical solution should concurrently provide vocal fold augmentation and re-establishment of tissue elasticity. Nanofat technique has given so far promising results in remodeling skin scars and improving tissue pliability. The present paper describes for the first time the use of nanofat injected into the vocal fold cover for pliability restoration, combined with traditional microfat for vocal fold augmentation. Seven patients (aged 23-77 years) affected by severe dysphonia, related to extensive vocal fold scarring (3 of them were also affected by dysphagia for liquid consistencies), underwent a single procedure of concurrent microfat and nanofat vocal fold injection under direct microlaryngoscopy in general anesthesia. Results were evaluated by objective outcome measures and auto evaluation performed by questionnaires concerning the phonatory and swallowing efficiency. The voice quality and the perceived swallowing capability of all patients improved after surgery and are stable at follow-up (4-8 months). The reported preliminary data show that nanofat, due to its regenerative potential related to adipose-derived stem cells and growth factors, can be a promising adjunct to traditional fat augmentation to improve elasticity of the delicate multilayered structure of the vocal fold and to enhance its vibratory capabilities. Further experience on a wider number of patients and long-term follow-up are necessary to confirm the validity of this technique.

Are Perioperative Antibiotics Necessary During Direct Microlaryngoscopy?

There are currently no established recommendations for the use of perioperative antibiotics (PAs) to prevent surgical site infections (SSIs) for direct microlaryngoscopy (DML). This study examined the incidence of SSI in patients undergoing DML with and without PAs. Retrospective, multi-institutional chart review. A retrospective, multi-institutional chart review was performed at four tertiary referral academic medical centers. Patients undergoing DML from 2010 to 2017 were identified using Current Procedural Terminology codes. Medical records of patients undergoing DML with biopsy, microsurgery, laser ablation, or vocal fold injection who had adequate follow-up were reviewed. Procedures with significant cartilage destruction, concurrent open surgery, or esophageal surgery were excluded. Data recorded included age, gender, pacemaker history, American Society of Anesthesiologists class, wound class, indication for surgery, use of laser, complications, emergency room visits, hospitalizations, pain, fever, and postoperative steroid and antibiotic prescriptions. Presence or absence of SSIs was evaluated by a fellowship-trained laryngologist. There were 834 patients who met inclusion criteria. Of those, 698 did not receive PAs and 136 received PAs. The median age of patients was 54 years of age in the PA group and 57.5 years of age in the non-PA group, and all cases were recorded as wound class II. Overall, 58% of surgeries involved use of carbon dioxide or potassium-titanyl-phosphate laser. Only one SSI was reported on follow-up in a patient who did receive PAs. SSIs are exceedingly rare following DML. PA use is not indicated for routine DML. 4 Laryngoscope, 128:2838-2843, 2018.

PROLONGED ENDOTRACHEAL INTUBATION

SESSION TITLE: Imaging SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 pm - 02:15 pm INTRODUCTION: Laryngeal injury following intubation is a well described complication and ranges from uncomplicated edema to subglottic stenosis with a trend toward more harm with increasing duration.The accepted time limit of an indwelling ETT at our hospital is 14 days after which tracheostomy is pursued if continued airway support is needed.This case report illustrates the findings in a patient with oral endotracheal intubation for 145 days, a duration that to our knowledge has not been reported in the past. CASE PRESENTATION: A 39-year old male was transferred from an outside hospital for neurosurgical evaluation after being found down with initial head CT showing extensive IVH presumed to be from tumor hemorrhage. The patient has a history of third ventricle and suprasellar ganglioglioma since age 16 with multiple prior surgeries and shunt placements requiring frequent tappings for symptomatic hydrocephalus. Initial GCS was 3 and he was intubated prior to arrival at our hospital for airway protection.He had an extended hospital stay due to the expected severe neurologic sequelae of the insult that was compounded by the family's lingering resistance toward any surgical intervention including tracheostomy, which led to the almost 5-month long intubation. After consent was eventually granted, the patient underwent direct microlaryngoscopy that showed no significant mucosal damage but revealed severe erosion of the posterior laryngeal commissure and post-cricoid area. He underwent successful tracheostomy with planned repeat laryngoscopy for possible steroid injection or mitomycin treatment to attempt to prevent cicatricial stenosis. DISCUSSION: The circumstances of intubation, patient comorbidities and the mechanical presence of a foreign object within the delicate structures of the larynx all contribute to the development of laryngeal injury. The majority of complications are minor enough to resolve on their own and although this case represents an extreme example, it demonstrates the significant and irreversible damage that can occur to laryngeal structures with long-term presence of an endotracheal tube CONCLUSIONS: In summary, this case demonstrates one of the possible consequences of an excessively prolonged intubation. Our hypothesis prior to visualization was that the vocal cords and ETT could have possible adhered to each other making removal impossible without dissection. However this posterior erosion one can wonder how long this could have persisted before encroaching on the esophagus. Reference #1: Long-term complications of artificial airways. Richard D Sue MD, Irawan Susanto MD, FACP. Clin Chest Med 24 (2003) 457-471 DISCLOSURES: No relevant relationships by Andrea Fekete, source=Web Response

Comparing Videostroboscopy and Direct Microlaryngoscopy: An Argument for Flexible Consent and Operative Plan

Office-based evaluation of glottic lesions has progressed significantly, but there can still be discrepancies compared with direct microlaryngoscopy (DML) in the operating room. We performed a prospective evaluation comparing diagnosis of epithelial and lamina propria glottic lesions on rigid telescopic strobovideolaryngoscopy (RTS) with DML. Fifty subjects were enrolled and underwent RTS followed by DML. We compared presence and extent (unilateral or bilateral) of lamina propria and epithelial lesions. Primary (diagnoses motivating an operation) and secondary (diagnoses not requiring an operation) were considered. Changes in diagnosis and operative plan based on DML findings were evaluated. Sixty-eight lesions were identified on RTS, including 53 primary (15 epithelial, 38 lamina propria) and 15 secondary diagnoses. RTS was accurate in only 36% of subjects. Ten subjects had a different primary pathology identified on DML. A change in surgical management occurred in 16% of subjects. This is the first prospective study evaluating how both diagnosis and operative plan for epithelial and lamina propria glottic lesions differ based on RTS and DML. Despite significant advances in office-based diagnosis of glottic lesions, there are still notable limitations. Clinicians should consider these findings when counseling patients on interpretation and plan for findings based on RTS. Obtaining a flexible surgical consent and counseling patients on the potential for new diagnoses and interventions based on DML is warranted.

Analysis of Pressure Distribution During Direct Microlaryngoscopy

This study aimed to investigate the pressure distribution during direct microlaryngoscopy and its relation with the positioning of the patient. This is a prospective study in cadavers. The pressure distribution during direct microlaryngoscopy was investigated in five adult fresh cadavers by using matrix-based piezoresistive thin-film sensors. The pressure among three head and neck positions (extension-extension, neutral, and flexion-extension) was studied. The real-time pressure and its distribution were recorded as 3-D contours. The map commonly showed two peak pressure points, with one focused on the middle of the laryngoscope (peak pressure 1) and the other one focused on the distal part of the laryngoscope (peak pressure 2). The mean average pressure in this study was 38 ± 13 kPa, and the flexion-extension position had the lowest average pressure and peak pressure. However, the average pressure and peak pressure 1 showed no significant difference among the three positions (P > 0.05); peak pressure 2 in the flexion-extension position was significantly lower than that in the extension-extension position (P = 0.024) and the neutral position (P = 0.020). The results of this study indicate that the flexion-extension position induced lower pressure exerted on the laryngoscope and is an optimal position for direct microlaryngoscopy. Hyoid bone may play an important role in the pressure exerted.

Factors Associated With the Use of Postoperative Analgesics in Patients Undergoing Direct Microlaryngoscopy.

Morbidity associated with suspension laryngoscopy has been well documented. However, standard of care with regard to postoperative analgesia has not been described, and anecdotal evidence suggests wide variability with regard to postoperative narcotic and non-narcotic recommendations. We sought to quantify the postoperative course following suspension microlaryngoscopy by relating patient-based and intraoperative measures with analgesic use. Body mass index (BMI), Friedman tongue position (FTP), and Mallampati scores as well as laryngoscope type, number of attempts required for optimal visualization, and suspension time were documented in 50 consecutive patients undergoing routine suspension microlaryngoscopy. Postoperative symptoms and analgesic use was queried on postoperative days 1, 3, and 10. In this cohort, 62.5% employed postoperative analgesia. However, only 20% required narcotics. No difference in suspension time was identified in those taking analgesics (33.0 vs 37.3 minutes, P = .44). In addition, no relationship between procedure type and the need for analgesia was noted. The majority of patients (76%) described sore throat persisting for 3 postoperative days; 36% reported sore throat persisting beyond postoperative day 3. The majority of patients undergoing microlaryngoscopy reported discomfort, but symptoms were largely ameliorated with over-the-counter analgesics. Routine prescription of narcotics following routine suspension laryngoscopy may be unnecessary.

Endoscopic management of congenital anterior glottic stenosis

IntroductionCongenital anterior glottic stenosis (web) is a rare condition usually presenting with airway obstruction, stridor or dysphonia. Symptomatic infants may require tracheotomy to bridge the neonatal period. Early open surgical reconstruction may have significant risks and failure may still result in tracheotomy. We introduce an endoscopic surgical approach with balloon dilation for primary management of congenital anterior glottic stenosis. MethodsWe present three cases of congenital anterior glottic stenosis in children 7, 14, and 90 days old presenting with stridor, dyspnea, and dysphonia. The larynx was exposed by suspension microlaryngoscopy. The glottic stenosis was incised from a posterior to anterior direction using a laryngeal sickle knife. Subsequently, an airway balloon was guided through the stenotic lumen. Once the balloon was inflated, the balloon pressure was maintained for 30s or until the patient's oxygen saturation dropped below 92%. The dilation was repeated two or three times. The patients were kept intubated with an uncuffed endotracheal tube and monitored in the pediatric intensive care unit following surgery. ResultsAll three patients were extubated within 72h without complications. One patient failed the first extubation attempt and was reintubated and successfully extubated 24h later. Patients were re-evaluated with direct microlaryngoscopy within two weeks. All patients had symptomatic relief and did not require further surgical intervention. ConclusionEndoscopic balloon dilation laryngoplasty may be a safe and effective primary procedure for pediatric patients with congenital anterior glottic stenosis. It is technically simple and obviates the potential morbidities associated with an open surgical procedure or tracheotomy.

WSPÓŁWYSTĘPOWANIE OBUSTRONNEGO ROWKA GŁOŚNI TYPU VERGETURE I OBUSTRONNEJ MASY WŁÓKNISTEJ FAŁDÓW GŁOWACH: STADIUM PRZYPADKU

BackgroundThis study presents the case of a 32-year old woman who presented with severe dysphonia. She had experienced voice problems since childhood.Material and MethodsThe patient underwent otolaryngological and phoniatric examination including videolaryngostroboscopy (VLS), perceptual evaluation (GRBAS scale), and acoustic analysis of voice (MDVP software). Microsurgery was performed using a CO2 Acupulse laser (Lumenis) with AcuBlade micromanipulator.ResultsVLS revealed glottal incompetence, an intracordal mass on the right vocal fold, and capillary ectasia on the superior surface of the right vocal fold. Atrophy was seen along the free edge of the left vocal fold. GRBAS and MDVP revealed significant voice disturbances. The patient was referred for direct microlaryngoscopy. Initial inspection of the vocal folds showed bilateral intracordal mass and sulcus vergeture. Using a microflap technique the fibrous mass was removed. For the sulcus vergeture a surgical technique based on a concept by Cornut and Bouchayer and modified by Remacle was used. Complementary hyaluronic acid (Surgiderm 24XP) was injected to correct the left vocal fold volume. Stroboscopic evaluation performed 3 months postoperatively showed significant improvement of glottis closure and vibratory parameters. Perceptual and objective voice assessment revealed improvement in the acoustic structure of the voice after surgeryConclusionsCoexistence of bilateral sulcus vergeture and bilateral fibrous mass is a very rare occurrence. The preoperative diagnosis is often not obvious. Severe voice disturbances make surgery the first treatment option in such cases.