Lateral thyrotomy approach on the paraglottic space for laryngocele resection

Transoral Endoscopic Excision of Laryngeal Schwannoma

OBJECTIVE

Schwannomas originating within the larynx are rare and there is no clear consensus on the diagnostic workup or treatment. This study aims to explore the clinical features of laryngeal schwannoma and evaluate the surgical method of transoral endoscopic excision, especially with coblation.

METHODS

Data from patients diagnosed with laryngeal schwannoma who underwent surgery at Peking Union Medical College Hospital from 2017 to 2022 were retrospectively analyzed. All cases were evaluated with a flexible laryngoscope and computed tomography and/or magnetic resonance imaging before surgery.

RESULTS

Four patients, comprising one male and three females aged 19 to 61years, were included. All patients presented with persistent and progressive hoarseness, and two also experienced dyspnea on exertion. One patient was a recurrent case who underwent transoral tumor resection with a laser, while another patient had received a transoral incisional biopsy before visiting our hospital. Transoral excision was performed in each case. One tumor was excised using microlaryngeal instruments under a microscope, and the other three with coblation assisted by an operating laryngoscope. All laryngeal schwannomas were removed in a single block. All patients were successfully extubated following surgery, recovered without complications, and showed no evidence of recurrence.

CONCLUSION

Transoral surgery better preserves laryngeal function, reduces complications, and shortens hospital stays. Transoral endoscopic excision, particularly when performed with coblation, is highly recommended for its excellent visualization and ability to completely excise the tumor. This method is a safe and effective approach, especially for large laryngeal schwannomas in hard-to-reach locations.

Bilateral Combined Laryngocele: Comprehensive Review of the Literature

Laryngocele, an abnormal dilation of the appendix of the laryngeal ventricle filled with air, is a rare condition predominantly presenting unilaterally. However, bilateral occurrences are exceedingly rare. In this article, we present a case of bilateral laryngocele along with a comprehensive literature review. A 57-year-old male presented with dyspnea, stridor, and bilateral neck masses. His medical history included chronic cough and intermittent hoarseness. Over a 3 month period, the neck masses progressively enlarged, resulting in respiratory distress. Interestingly, he denied experiencing weight loss, decreased appetite, or fever. Clinical examination revealed sizable, soft masses on both sides of the neck, obstructing lymph node assessment. Computed tomography (CT) imaging confirmed the presence of a left combined laryngopyocele and a right combined laryngocele. Subsequently, the patient underwent tracheostomy. Benign biopsy results excluded malignancy. Surgical excision of bilateral laryngoceles resulted in an uneventful recovery. The term "laryngocele" was introduced by Virchow in 1867 to describe the abnormal dilation of the saccule associated with Morgagni's ventricle. Diagnosis involves a thorough patient history, physical examination, and radiological imaging, notably CT, to differentiate laryngoceles from other conditions. Typically asymptomatic, they are often incidentally discovered around age 50, although symptoms such as voice changes or breathing difficulties can manifest. A review of the literature identified 77 documented cases, primarily in males, exhibiting various symptoms and treatment modalities. This case underscores the rarity of bilateral combined laryngocele, emphasizing the importance of timely diagnosis and surgical intervention for favorable outcomes. Comprehensive research reveals diverse clinical aspects, highlighting the necessity for continued investigation to enhance management strategies.

Single Stage Conservative Surgery to Avoid Recurrence in Combined Laryngocele: Important Modifications

Laryngocele is very uncommon and no consensus regarding its surgical management is yet established. While traditional external approach is still being recommended some suggest a better microlaryngoscopic management assisted by CO2 laser that has gained popularity. Recurrence is better known with conservative surgery but this paper presents a modified single stage endolaryngeal technique for combined laryngoceles to overcome the same. The salient features are (1) A comparatively larger operculum is created and all the visible mucosa is excised; (2) the base of residual postoperative cavity is moistened with cotton soaked with concentrated carbolic acid for 1 min and (3) the residual 'charred' base with intermittent oozing is packed with single layer of surgicel. The reader is further encouraged to see surgical video of entire procedure.

Mixed laryngocele mimicking thyroid nodule

Laryngocele is defined as a dilation of the laryngeal saccule forming an air sac. Some differential diagnoses for laryngocele have been reported. The aim of the present paper was to describe a case of a patient referred for the evaluation a suspected thyroid nodule that was subsequently diagnosed as a mixed laryngocele. A 31-year-old male with no clinical manifestations was referred by an endocrinologist to undergo Doppler ultrasonography and fine-needle aspiration biopsy due to a preliminary ultrasonographic diagnosis of a nodule apparently in the thyroid. The diagnosis of laryngocele was raised considering the cytopathological analysis and imaging exam. Computed tomography of the neck confirmed this hypothesis. The patient was counseled to consult a surgeon, but, up to the end of this report, continued asymptomatic and in follow-up. We report a mixed laryngocele with different clinical behavior, showing that laryngocele may appear to be another entity and drawing the attention of clinicians to imaging similarities.

Thyroid chondroplastic flap for resection of laryngoceles

PURPOSE

Large and combined laryngoceles usually need an external approach. One difficulty in such approach was the dissection at the paraglottic space. To overcome such difficulty, a thyroid chondroplastic flap approach to the paraglottic space was designed.

METHODS

This study is a case series of thirty consecutive patients (24 men and six women with an average age of 45.6 years), having large combined laryngocele resected externally between January 1995 and December 2019) at the department of ORL_HNS Tanta University, Egypt.

RESULTS

This approach allowed for excellent exposure of the paraglottic space, facilitating complete resection. Complications included perichondrial tearing in five patients, obstructing hematoma in two patient and minimal edema in four patients.

CONCLUSIONS

Thyroid chondroplastic flap is an excellent and safe approach for the paraglottic space facilitating complete resection of large laryngoceles.

Left mixed laryngocele in absence of risk factors: A case report and review of literature

Laryngocele is an uncommon benign cystic dilatation of the laryngeal saccule that communicates with the laryngeal lumen and contains air. On the basis of its localization, it can be traditionally classified in internal, external, or mixed. Usually unilateral and rarely bilateral, it may be congenital or acquired. It most often appears later in life without important symptoms except for cervical swelling. Here, together with a review of literature, we report the case of a 72-year-old man, smoker but without other specific risk factors, who presented laryngeal dyspnea for about one year. Neck CT scan performed during a previous hospitalization for respiratory failure revealed a left mixed laryngocele that was later surgically removed with cervicotomic access. The patient was discharged after one week. One month after surgery, we confirmed the absence of disease with video laryngoscopy.

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Laryngocele is a rare benign cystic dilatation of laryngeal saccule.

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Conditions increasing intraluminal laryngeal pressure are the main risk factors.

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The diagnosis of laryngocele is essentially clinic, based on symptoms.

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In some cases it can present with acute respiratory failure as pulmonary pathology.

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Treatment is surgical excision, microlaryngoscopic, external or combined.

Systematic review of laryngocele and pyolaryngocele management in the age of robotic surgery

OBJECTIVE

A laryngocele is a space that develops as a result of pathological dilatation of the laryngeal saccule. However, the reported management of laryngoceles varies. We conducted a systematic review of the literature regarding the surgical management of laryngoceles and pyolaryngoceles, to understand the evolving nature of treatment for this rare condition.

METHODS

We searched for publications in the PubMed, Cochrane Library, JBI Library of Systematic Reviews, and Ovid databases using the terms "laryngocele", "pyolaryngocele", and "laryngopyocele", and reviewed the identified articles.

RESULTS

After removal of repeated studies and filtering for relevance and studies written in English, a total of 227 studies were included in this review. No meta-analyses or randomized controlled trials have been published. The identified studies have been summarized in 14 reviews conducted since 1946. The meta-analysis determined that endoscopy was the preferred approach for internal laryngoceles, while combined laryngoceles benefited from both internal and external surgical approaches.

CONCLUSIONS

Laryngocele management has progressed since its initial description, from open surgery to an endoscopic approach, and more recently to a robotic-assisted surgical approach. The uptake of robotic surgery as a possible treatment modality over the last decade shows much promise for the treatment of these conditions.

Nontraumatic Head and Neck Emergencies

Head and neck imaging is an intimidating subject for many radiologists because of the complex anatomy and potentially serious consequences of delayed or improper diagnosis of the diverse abnormalities involving this region. The purpose of this article is to help radiologists to understand the intricate anatomy of the head and neck and to review the imaging appearances of a variety of nontraumatic head and neck conditions that bring patients to the emergency department, including acute infectious and inflammatory diseases and acute complications of head and neck neoplasms. These conditions are presented in five sections on the basis of their primary location of involvement: the oral cavity and pharynx, neck, sinonasal tract, orbits, and ears. Important anatomic landmarks are reviewed briefly in each related section.Online supplemental material is available for this article.^©RSNA, 2019.

Blunt Trauma to the Neck Presenting as Dysphonia and Dysphagia in a Healthy Young Woman; A Rare Case of Traumatic Laryngocele

Laryngocele is not a common clinical entity that presents itself in a trauma setting. In the literature, there are currently two types of laryngocele, internal and mixed. Laryngocele may be congenital or acquired, and most often will present later in life. Traumatic laryngocele has only been reported three times in the literature before. Herein, we report a rare case of a 22-year-old woman who presents with bilateral laryngocele secondary to sustained direct trauma. Neck Ct-scan revealed bilateral laryngocele being responsible for her dysphagia and dysphonia. She was monitored in the hospital for further exacerbation of her symptoms with feared airway occlusion in mind. On hospital day three, her dysphagia had resolved and her dysphonia had significantly improved. A second CT, revealed resolution of left laryngocele with the right decreased in size since the initial presentation. She was followed and had complete resolution of symptoms one week after the injury.

Laryngocele: A Rare Case Report and Review of Literature

Laryngocele is an abnormal cystic dilatation of the saccule of the larynx. It communicates with the laryngeal lumen and contains air. Laryngocele can be classified as internal (within the larynx), external (outside the larynx) and mixed (both). It is a rare entity. Hereby, we are reporting a case of laryngocele, which presented to us with a diagnostic quandary. After confirming the diagnosis by radiology, patient was operated upon by external approach. In the following article, we also discuss the establishment of the diagnosis and review different surgical modalities for the management of various types of laryngocele.

Bilateral Laryngocele Causing Epiglottic Deformity and Upper Airway Obstruction

Laryngocele is the cystic dilatation of laryngeal ventricle. Most cases are asymptomatic and incidentally diagnosed in radiologic examinations. Although the etiology is unclear, obstruction, laryngeal pressure, congenital defects are possible risk factors. Computed tomography is the best method for diagnosis. Endoscopic, external or combined approaches have been described in the surgical treatment. Laryngocele should be kept in mind in patients with acute upper airway obstruction. Such patients may require tracheostomy. Some patients with laryngocele can also have laryngeal cancer, in which case direct laryngoscopy must be performed. This report presents a case with respiratory distress associated with bilateral laryngocele, and his management in the light of the literature.

Transoral robotic excision of laryngocele: Surgical considerations

BACKGROUND

Transoral robotic surgery (TORS) has emerged as a novel, safe, and feasible procedure for the resection of malignant supraglottic laryngeal cancers. The purpose of this study was to demonstrate the surgical technique with extension of the use of TORS to excise a laryngeal cyst.

RESULTS

Laryngeal cyst resection, along with its tract, was accomplished with preservation of both false and true vocal cords. There was no perioperative or early postoperative complications. The patient was extubated immediately after surgery. Oral diet was initiated within 24 hours. No tracheostomy was required. A video demonstration of the surgical technique is included on Head & Neck's website.

CONCLUSION

TORS is a safe and feasible procedure for excision of selected laryngeal cysts.

Laryngoceles: Concepts of diagnosis and management

A laryngocele is an abnormal dilatation of the laryngeal saccule. It is a rare benign lesion of the larynx. Various modalities of treatment have been advocated for its management. We present our treatment results and outcomes of a series of cases of laryngoceles and discuss the concepts of their management. This study included patients with different laryngocele types. Patients with an internal laryngocele underwent endoscopic CO₂ laser resection, while those with a combined laryngocele underwent resection via a V-shaped lateral thyrotomy approach. Seven patients had an internal laryngocele, and 4 patients had a combined laryngocele. Hoarseness and neck swelling were the most common symptoms. The mean follow-up period was 8.5 months. None of the patients needed a tracheostomy either preoperatively or postoperatively, or had recurrence of laryngocele. We advocate the lateral thyrotomy approach for combined laryngoceles as it provides safe, precise, and complete resection under direct visualization via a single approach, while we favor the endoscopic laser approach for the internal ones as it allows resection of the entire lesion with minimal laryngeal trauma, less operative time, and a shorter hospital stay.

Management of laryngoceles by transoral robotic surgery

We herein report our experience with the management of laryngoceles using transoral robotic surgery (TORS). A bicentric retrospective study was conducted from November 2009 to September 2015. The inclusion criteria were treatment of a laryngocele by TORS and no malignancy on definitive histopathology. Surgery was performed using the Da Vinci (Intuitive^®) surgical robot. Surgical methods and post-operative outcomes were evaluated. Eight patients (four men and four women) presenting with a laryngocele (one bilateral case) were included (mean age 61.8 years). There was one covering tracheotomy. The average post-operative stay was 3.75 days. Three patients treated for a combined laryngocele had a nasogastric feeding tube inserted for 5 days. One patient experienced late laryngeal bleeding that required surgical treatment. TORS may offer an efficient treatment option for laryngoceles. The use of precise and flexible instruments and a three-dimensional camera allow fine dissection of these tumours, preserving the glottic space and vocal function, even for combined laryngoceles extending deep within the neck.Evidence level: 4.

Laryngeal schwannoma: a systematic review

A large proportion of schwannomas are found in the head and neck region. Schwannoma located within the larynx however is uncommon. The characteristic features, clinical presentations, treatment and the outcomes of patients with laryngeal schwannoma are therefore not clearly understood. The aim of this comprehensive review is to compile, analyze and present the details to develop a consensus and augment the available literature on laryngeal schwannoma. A comprehensive literature search on laryngeal schwannoma was performed on PUBMED/MEDLINE, EMBASE, CINAHL and Science Citation Index using MeSH words. A total of 55 patients were reviewed in this study. 40.7 % of the tumours arose from the aryepiglottic fold or arytenoids. Other areas where tumours were found included the false cord, true vocal cord, epiglottis, subglottis, piriform sinus and the post cricoid area. 64.9 % patients presented with dysphonia. Others typically present with multiple symptoms related to the mass effect and location of the tumour. All patients were managed surgically with different techniques and approaches. Majority of patients were alive with no residual disease. There were five recurrences and no mortality to date. Schwannoma within the larynx can present with a variety of symptoms. Surgical excision remained as the treatment of choice with good overall prognosis.

Congenital laryngomucocele: a rare cause of airway obstruction in a newborn

Congenital laryngoceles are defined as cystic dilatation of laryngeal saccules and are an extremely rare cause of newborn respiratory distress. A laryngomucocele occurs when the neck of the laryngocele gets obstructed and fills with the mucoid secretions of the saccule. It may cause stridor, respiratory distress, and severe airway obstruction in the narrow airway of a newborn and necessitates urgent surgical intervention. There is only 1 case of congenital laryngomucocele reported in an autopsy examination in the English literature, and here we report the first living congenital laryngomucocele case and discuss the clinical approach.

Combined laser and robotic approach for the management of a mixed laryngomucocele

Treatment of laryngoceles is surgical resection, through an external approach for external laryngoceles and through an endoscopic approach for internal laryngoceles. We report the first case of a mixed laryngomucocele treated with transoral robotic surgery. A patient presented with a history of chronic cough. Nasolaryngoscopy showed a sub-mucosal swelling into the larynx. Computed tomography confirmed the diagnosis of a right mixed laryngomucocele. A transoral robotic- and laser-assisted surgery was performed. Oral feeding was started on the first post-operative day. No post-operative complication was observed. There has been no evidence of recurrence during the following months. The generally used external and endoscopic approaches each have their limits in the treatment of laryngoceles. Transoral robotic surgery allows a minimally invasive approach with a wide exposure, making possible an absence of scar and a good functional recovery after the operation. Transoral robotic approach seems to allow an endoscopic approach for mixed and external lesions. Transoral robotic surgery combined with laser is an efficient minimally invasive technique and is the best option for the treatment of mixed laryngoceles and laryngomucoceles.

Supra-thyroid alar cartilage approach for the complete resection of laryngeal submucosal tumors and postoperative voice quality

Various surgical approaches for the treatment of laryngeal submucosal tumors have been reported. Endoscopic excision is indicated for small lesions, while external approaches are recommended for larger tumors. This report introduces a supra-thyroid alar cartilage approach (STACA), which has strong advantages for the preservation of the laryngeal framework and voice recovery after surgery. Case series with chart review. Four patients with laryngeal submucosal tumors in the paraglottic space underwent complete tumor removal through STACA. Medical charts were reviewed to evaluate patient background, major complaints, tumor type, tumor size, the time period from operation to tracheostomy closure, tumor recurrence, and the difference between pre- and postoperative voice quality. Voice quality was assessed using the GRBAS score, maximum phonation time (MPT) and Voice Handicap Index-10 (VHI-10) 6 months after surgery. All patients were females between 43 and 67 years of age. Two patients had schwannoma, one laryngocele, and one lipoma. Mean tumor size was 3.4 cm. The main complaints were hoarseness in all patients, and dyspnea in one. The periods of time from surgery to oral intake and tracheostomy closure were 3.5 and 7 days, respectively. No patient developed recurrence during a minimum follow-up period of 2 years. The postoperative GRBAS scores, MPT and VHI-10 improved in all patients. STACA has advantages including minimal trauma, no deformity to the laryngeal framework, and good voice qualities after the resection of laryngeal submucosal tumors.

A new preserved technique for laryngocele: modified lateral thyrotomy approach

Laryngocele is a benign abnormal dilatation of the laryngeal saccule. We present a 30-year-old male patient who complained with hoarseness since 1 year. Paraglottic laryngocele is detected on medical examination. The patient is operated on successfully with our new thyroid cartilage preserved technique (modified lateral thyrotomy method).

Treatment of Laryngoceles: what is the progress over the last two decades?

OBJECTIVES

To review surgical techniques used in the treatment of laryngoceles over the last two decades and point out developments and trends.

MATERIALS AND METHODS

PubMed, the Cochrane Library, and the JBI Library of Systematic Reviews were searched using the term "laryngocele." Demographic data, type of laryngocele, presence of a laryngopyocele, type of treatment and need for a tracheotomy were assessed.

RESULTS

Overall, data on 86 patients were analyzed, culled from 50 articles, of which 41 were case reports and 9 were case series. No single systematic review or meta-analysis or randomized controlled trial has been published on the topic. Altogether, 71 laryngoceles in 63 patients met the criteria for further analysis focusing on surgical treatment. An external approach was selected in 25/29 (86.2%) cases of combined laryngoceles. Microlaryngoscopic resection using a CO2 laser was performed in three cases and endoscopic robotic surgery in one case. The majority of patients with an internal laryngocele, 31/42 (73.8%), were treated using the microlaryngoscopy approach.

CONCLUSIONS

Microlaryngoscopy involving the use of a CO2 laser has become the main therapeutic procedure for the treatment of internal laryngoceles during the past 20 years. An external approach still remains the main therapeutic approach for the treatment of combined laryngoceles.

Surgical and anesthetic considerations of laryngeal saccular cyst: a case report

Introduction

Supraglottic laryngeal cysts are benign, uncommon lesions that have the potential to cause airway compromise.

Case Presentation

We present a case of a 46-year-old Caucasian woman who was scheduled for excision of a large neck growth (saccular cyst) and was managed successfully. There was thorough consideration regarding anesthetic and surgical management. Steps taken led to a successful excision with no recurrence during follow up.

Conclusion

This case was an opportunity to consider the challenges in the airway management associated with such cysts and provided reassurance that excision of these cysts is associated with a good post-operative outcome.

Schwannoma mimicking laryngocele

A schwannoma of the larynx is a rare benign tumor that usually presents as a submucosal mass in the pyriform sinus and the aryepiglottic space, and this type of schwannoma constitutes a diagnostic and therapeutic challenge for otolaryngologists. We present here two cases of supraglottic schwannomas that were misdiagnosed as laryngoceles. Both were excised through a lateral thyrotomy approach without a tracheostomy, and the laryngeal function was successfully maintained. We discuss the clinical and imaging findings and the management of this rare neoplasm with focusing on the differential diagnosis of laryngeal schwannoma and laryngocele. We also review the relevant medical literature.

Laryngoceles - presentations and management

INTRODUCTION

Laryngoceles usually present as cervical masses with or without hoarseness of voice. They are mostly unilateral and may be symptomatic or asymptomatic. They are classified as internal, external or combined. They have been described to be an occupational hazard among wind instrument players or glass blowers. They also occur in association with neoplasms of the larynx.

MATERIALS AND METHODS

Here we report five patients with laryngoceles of whom two had bilateral laryngoceles, which are very rare. One patient had associated laryngeal malignancy for which total laryngectomy was performed. Two cases underwent excision via cervical approach. The rest were managed conservatively.

CONCLUSION

Symptomatic cases have to be managed surgically while asymptomatic ones may be managed conservatively.

Laryngocele - a case report and review of literature

This is case report of 35-year old male patient presented with hoarseness and swelling on left side of neck. The swelling was noticed by the patient for 8 months. It has been diagnosed clinically and radiologically as a combined laryngocele. The laryngocele has been successfully excised using and combined approach i.e., external and endoscopic methods. This case has been reported for its rarity at this age.

Transventricular chondroplastic laryngotomy--a new surgical technique for the endolarynx

Current surgical techniques for laryngeal exposure pose distinct limitations. To address these issues, this article describes a novel surgical technique. Our technique, termed Transventricular Chondroplastic Laryngotomy, allows for extensive and direct external access to the endolarynx. This procedure is described in both a cadaver and animal models. Three pigs were submitted to thyroid cartilage window opening without touching the laryngeal ventricle, and seven animals were submitted to the full procedure, opening a thyroid cartilage window with wide ventricular opening. The animals were sacrificed 20 days following the procedure. Prior to sacrifice, all animals underwent laryngoscopic examination and following euthanasia, the larynx and cervical regions were examined grossly, in addition to histologically. This surgery allowed for extensive exposure of the ipsilateral vocal fold and the contralateral hemilarynx, through the laryngeal ventricle, and thus enabled bi-instrumental handling of the vestibular fold, laryngeal ventricle, and from the anterior commissure to the arytenoids, bilaterally. No postoperative complications were observed. Access to the ventricle was easily and directly achieved through the thyroarytenoid muscle. We hypothesize that transventricular chondroplastic laryngotomy will emerge as the surgical technique of choice in patients presenting with difficult exposure and/or traditional surgical instruments are not feasible. Future transventricular chondroplastic laryngotomy clinical applications of the procedure are discussed including the resection of lesions and more complex reconstruction of vocal folds.

Current diagnosis and treatment of laryngocele in adults

OBJECTIVE

To evaluate the treatment outcome of a series of laryngoceles and to comment on the current diagnosis and management of laryngoceles.

STUDY DESIGN AND SETTING

A retrospective review of charts, radiological and histopathological notes, videolaryngostroboscopic records, and acoustic voice analyses of patients with laryngocele treated over a 10-year period was undertaken.

RESULTS

Seven patients had internal laryngoceles; one had external; another one had combined laryngocele. Patients with internal laryngocele underwent endoscopic CO2 laser resection, while those with external or combined laryngocele were treated via external approach. Quality of voice was improved and no recurrences were encountered during the follow-up. No evidence of laryngeal cancer was found on the histological examinations.

CONCLUSION

Endoscopic CO2 laser resection of internal laryngocele provides a reliable and cost-effective method that minimizes hospitalization and the need for tracheotomy. We believe that advances in the applications of laser in microlaryngosurgery will alter the traditional management of all type of laryngoceles.

Lateral thyrotomy with strap muscle transposition for Teflon granuloma

Lateral thyrotomy and strap muscle transposition have been used independently before. However, the published literature does not record the coordinated use of both procedures in the treatment of Teflon granuloma. In this paper, we present a case of vocal fold paralysis that had been treated successfully by Teflon injection in 1999. Two years later, however, the patient developed a host of symptoms that included a husky voice, shortness of breath and suffocation, which indicated Teflon granuloma. He underwent surgery to excise the Teflon granuloma via a lateral thyrotomy. The affected paraglottic space was then reconstructed using strap muscle transposition. One year postoperatively, the glottis had closed completely on phonation, and the voice retained a moderate roughness due to a scarring change from the earlier Teflon reaction. The patient had no problems with aspiration or shortness of breath during speaking. Our experience indicates that a physician can remove the entire granuloma and create a smooth, straight vibratory surface with complete glottic closure during phonation by using a combination of lateral thyrotomy and strap muscle transposition.

[Onco-surgical significance of anatomo-morphological specificity of glottic region of the larynx]

Glottis is a medium level of the larynx, involving the vocal cords, vocal process of arytenoid cartilage, and the anterior and posterior commissures. This region of heterogeneous histomorphological structure has specific characteristics: the internal striated muscles, the outer and inner perichondrium, atypical intra-cartilaginous areas of ossification, and unusual muscular insertion to cartilage. Microtomy of 3 thick successive sections was performed at the level of the upper surface of vocal cords. Standard histological staining methods were used. Microphotographs were taken by light microscope under different magnification along with histomorphometric measurements. Cancer spread is partially restricted by anatomic barriers: vocal ligament and tendon of the anterior commissure, and subsequently by the elastic cone. Easier tumor extension may be due to absence of the internal perichondrium and ossification of thyroid cartilage. Microvascularization of the anterior commissure is significant for tumor spread in glottis and paraglottic space. The role of commissural lymph network in local spread of the cancer is completely vague. It is certain that there are causes, still unrecognized, which have an effect on the pathways and direction of malignant tumor spread.

Laryngocele resection by combined external and endoscopic laser approach

Options in the management of laryngoceles include observation, endoscopic resection, and resection via an external approach. We introduce a combined endoscopic and external approach that we have employed on several occasions to ensure complete removal of the laryngocele and the saccule from which it originated. A case is presented to help define the technique.

Endoscopic CO2 laser management of laryngocele

OBJECTIVE

To report on the management of laryngoceles by CO2 laser-assisted endoscopic excision.

STUDY DESIGN

A 15-year retrospective study of 12 adult patients (7 men and 5 women) who presented with a laryngocele. Nine patients had an internal laryngocele, one patient had an external laryngocele, and two patients had combined internal-external components. Two laryngoceles were right-sided, six were left-sided, and four were bilateral.

METHODS

An endoscopic examination of the laryngocele was carried out for both diagnostic and therapeutic purposes. Once identified the air- or mucus-filled cyst (extending from the laryngeal ventricle into the paraglottic space and beyond the thyrohyoid membrane in some cases), the laryngocele was excised in toto, with its surrounding capsule, via endoscopic approach using the CO2 laser.

RESULTS

The main presenting symptom was dysphonia in seven patients, visible or palpable mass in the neck in three, and upper airway obstruction in the remaining two. All laryngoceles were treated with endoscopic laser excision of the internal and external components when required. The average postoperative stay in hospital was 1.8 days. Only two of the patients treated had a tracheotomy; both cases presented elsewhere with an emergency airway obstruction, which necessitated tracheotomy. In these two cases, decannulation was subsequently performed. There were no significant complications. The follow-up ranged from 6 months to 5 years.

CONCLUSION

CO2 laser-assisted endoscopic excision of a laryngocele is a quick, precise, and safe alternative to an external approach excision (lateral thyroidotomy, laryngofissure) with fewer complications than its external counterparts, resulting in speedier rehabilitation of both the patient and his or her voice.