Operative management of benign nonepithelial solid laryngeal tumors Publication date: Available online 11 November 2019 Source: Operative Techniques in Otolaryngology-Head and Neck Surgery Author(s): Shivani Shah-Becker Most benign tumors of the larynx are epithelial in origin, with nearly 85% being laryngeal papilloma. Nonepithelial laryngeal tumors are uncommon and more than 50% of these are malignant. Therefore, benign nonepithelial solid tumors of the larynx are quite rare. The management of these tumors varies based on the site of origin, specific pathology, tumor size, and risk for malignant transformation. Most are ultimately treated with complete surgical excision, although the potential response of the tumor to adjuvant therapy may play a role in decision making. In this article, general approaches to surgical excision of these benign nonepithelial laryngeal tumors is discussed.

Surgery for vascular laryngeal lesions Publication date: Available online 8 November 2019 Source: Operative Techniques in Otolaryngology-Head and Neck Surgery Author(s): Bridget D. Burgess, Simon Best, Alexander Hillel, Lee Akst Vascular lesions of the larynx are those created by phonotrauma resulting in subepithelial bleeding. These are typically divided into 2 categories, hemorrhagic polyps and fibrovascular lesions (vocal nodules). Both of these types of lesions can disrupt the natural vibration of the vocal folds and cause dysphonia. In those patients whose voices are their livelihood, complete removal with preservation of as much normal superficial lamina propria and squamous epithelium is paramount. Here, we describe proper in office assessment with stroboscopy, options for treatment, and techniques in surgical excision.

Lasers in laryngeal surgery Publication date: Available online 8 November 2019 Source: Operative Techniques in Otolaryngology-Head and Neck Surgery Author(s): Ashley P. O'Connell Ferster The use of lasers in laryngology has evolved over the last several decades. With improving optics, instrumentation, and applications for treatment, lasers are now routinely used during laryngeal surgery performed in both the operating room and clinic settings. A variety of laser types, including carbon dioxide (CO2), potassium-titanyl-phosphate (KTP), and pulsed-dye lasers, are used to treat an array of benign laryngeal lesions. Otolaryngologists can now consider the use of lasers to treat benign vocal fold lesions including vocal fold polyps, varices/ectasias, scar, granulomas, recurrent respiratory papillomatosis, Reinke's edema, and nodules, among others. Knowledge of available lasers and common uses aids in providing the most appropriate treatment for a variety of benign laryngeal lesions.

Airway management in laryngeal surgery Publication date: Available online 1 November 2019 Source: Operative Techniques in Otolaryngology-Head and Neck Surgery Author(s): Verghese T. Cherian, Sonia J. Vaida Airway management and anesthesia for laryngeal surgery poses many challenges. A preoperative endoscopic airway examination and discussion with the otolaryngologist helps in planning the anesthetic management. Although, securing the airway using specialized endotracheal tubes is possible in the majority of cases, the surgeon may occasionally request a “tubeless” field. This can be achieved by ventilating the lungs using jet ventilation or high flow nasal oxygen (HFNO) while providing total intravenous anesthesia. Therefore, in addition to the “difficult airway” cart, equipment to provide HFNO and a high-pressure source of oxygen to provide jet ventilation should also be available.

Introduction Publication date: Available online 1 November 2019 Source: Operative Techniques in Otolaryngology-Head and Neck Surgery Author(s): Guy Slonimsky

Instrumentation in endoscopic laryngeal surgery Publication date: Available online 1 November 2019 Source: Operative Techniques in Otolaryngology-Head and Neck Surgery Author(s): Eran E. Alon, Michael Wolf The development of transoral endoscopic approaches to the larynx have revolutionized the way we evaluate and treat various laryngeal pathologies. Nowadays, there is a large spectrum of laryngoscopes to address the various age groups, clinical needs, laryngeal pathologies, and subsites. The current paper is a review of some of the various laryngeal instruments used today in the evaluation and treatment of laryngeal pathologies. The review will cover some of the different means for evaluation of the larynx, various sizes and shapes of laryngoscopes, unique subsites in the larynx for which special laryngoscopes have been developed and finally will offer a number of pearls that may assist in achieving the best exposure and treatment outcomes.

Laryngeal imaging Publication date: Available online 1 November 2019 Source: Operative Techniques in Otolaryngology-Head and Neck Surgery Author(s): Einat Slonimsky The purpose of this article is to describe key anatomical feature of the larynx and to review contemporary imaging protocols for the evaluation of nonmalignant lesions and pathologies of the larynx. The role of computed tomography (CT), magnetic resonance imaging, and positron emission tomography CT in the evaluation of laryngeal pathologies will be addressed. Imaging feature in CT and magnetic resonance imaging is discussed in particular conditions, such as cysts and laryngoceles, nonsquamous laryngeal lesions including laryngeal vascular lesions and vocal cord paralysis.

Surgical anatomy of the larynx Publication date: Available online 1 November 2019 Source: Operative Techniques in Otolaryngology-Head and Neck Surgery Author(s): David Bailey, David Goldenberg This article provides a review of the surgical anatomy of the larynx. The external cartilaginous and bony framework of the larynx are described in relation to how these structures can be used as landmarks to identify internal features of the larynx. The overlying musculature of the larynx is also detailed. The spaces of the internal larynx are explained including the pre-epiglottic, paraglottic, and cricoid area by their borders and contents to assist in orienting the surgeon. The course of vasculature and nerves within the larynx is described in detail. This includes the anatomical variants of the External Branch of the Superior Laryngeal nerve described by both Cernea and Friedman as well as variations in the Recurrent Laryngeal nerve. Finally, the musculature, mucosa, and cartilaginous structures of the internal larynx are described.

Surgery for adult laryngeal papillomatosis Publication date: Available online 26 October 2019 Source: Operative Techniques in Otolaryngology-Head and Neck Surgery Author(s): Adi Primov-Fever, Ory Madgar Recurrent laryngeal papillomatosis is a viral (human papillomavirus) disease that causes the growth of epithelial verrucous lesions. Patients with laryngeal papillomatosis undergo multiple surgeries due to the tendency of the lesions to reoccur and cause recurrent voice and breathing problems. The goal of the surgical treatment is to remove the lesions while protecting the delicate layered structure of the vocal folds in order to prevent scarring and permanent damage to the mucosa. This is a review of the currently performed operative procedures for treating recurrent adult laryngeal papillomatosis. They involve the use of cold instruments, lasers, and microdebriders. There is a trend towards preferential use of microdebriders and office-based laser procedures in compliant patients. There is no consensus on any surgical method of choice, and further investigations and long-term results of the ones in current use are warranted to provide more clear-cut guidelines for optimal management.

Robotics in laryngeal surgery Publication date: Available online 24 October 2019 Source: Operative Techniques in Otolaryngology-Head and Neck Surgery Author(s): Stefan Mattheis, Timon Hussain, Benedikt Höing, Pia Haßkamp, Laura Holtmann, Stephan Lang While transoral laser microsurgery has been the gold standard for laryngeal surgery for many years, recently transoral robotic surgery (TORS) has become a new treatment option not being restricted to a straight line of view which can be an obstacle during resection. In combination with specifically designed retractors TORS can provide a superior visualization and allows tissue manipulation especially in the narrow working space of the larynx. The present article describes the commercially available robotic systems suitable for transoral surgery in adult benign laryngeal masses and highlights on the use of TORS retractors. Additionally, the most relevant benign laryngeal masses in adults will be addressed with special emphasis on transoral robotic accessibility, visualization, and surgical resection techniques. Additionally, using the Medrobotics system TORS was evaluated for surgery of benign laryngeal masses in 37 adults suffering from cysts, polpys, papillomas, dysplasias, and leukoplakias: Excellent visualization, surgical access to all lesions and complete resection without any severe side effects could be achieved. In conclusion, TORS can be a valuable tool in surgery for adult benign laryngeal masses.