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Endoscopic Resection of Vocal Cord Leukoplakia - Orientation for Pathology after "Floating the Lesion" (video)

last modified on: Thu, 12/05/2024 - 10:37

Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation
Resection vocal cord lesion with suture orientation

"Floating the Lesion"

return to: Laryngeal Surgery (Malignant Disease) Protocols; Laryngeal Surgery (Benign Disease) Protocols

see also: Microdirect Laryngoscopy (Suspension Microlaryngoscopy or Direct Laryngoscopy); Laryngeal leukoplakia white plaques on vocal cords

click on arrow below to begin video (no audio):

Modified Operative Note

Procedure: Microdirect laryngoscopy with resection of right vocal cord lesion, culture of left vocal cord, Esophagoscopy

Preop Diagnosis:

Tobacco user with dysphonia and right anterior TVC lesion who presents for microdirect laryngoscopy and esophagoscopy with biopsies

Postop Diagnosis:

Same

Procedure Details:

Following identification of the patient and informed consent reiterated the patient taken back to the OR and placed in supine position. A time out was effected and followed by administration of general endotracheal anesthesia with full relaxation was conducted using a 5-0 MLT endotracheal tube.

The patient was turned 90 degrees away from anesthesia.

Flexible esophagoscopy was conducted and revealed no abnormalities.

Microdirect laryngoscopy was then performed with use dental protection and placement of a Lindholm laryngoscope achieving good exposure of the larynx identifying white material on the left vocal cord wiped free with an applicator tip and sent for culture.  Similar wiping action of the applicator tip failed to dislodge the right vocal fold lesion.  The identified right vocal fold lesion lesion was then “floated” by injecting lidocaine 1% with epinephrine 1:100,000 into Reinke's space using the Xomed-Treace Oro-Tracheal Injector.

Resection accomplished employing Feder Ossoff instruments (heart shaped forceps / straight up-bithing scissors / curved scissors) coupled with a folded afrin soaked pledgets. The lesion was excised completely and marked with a 6-0 suture placed through the anterior aspect of the specimen and through the underlying telfa to secure it – with drawing on the telfa indicating the orientation on the right vocal cord. Hemostasis was achieved using afrin soaked pledgets. The case concluded, and the patient was turned over to anesthesia in stable condition.

Photodocumentation was carried out throughout the case.

Findings:

Right vocal fold leukoplakia grossly resected in entirety and marked for pathologic review of margins.

Left vocal fold superficial white lesion removed with culture tip

Unremarkable flexible esophagoscopy