Return to: Glossopharyngeal nerve block (gag reflex, transoral vocal cord surgery);
Superior Laryngeal Nerve Blocks Instruction Video; Maximum Recommended Doses and Duration of Local Anesthetics
KTP Laser for the Larynx; Setup for awake KTP Laser Treatment through Flexible Transnasal Laryngoscopy in Main Operating Room for RRP; Transdermal scopolamine and glycopyrrolate for sialorrhea and salivary fistula
Modified Operative Note:
Procedure: Transnasal flexible laryngoscopy with KTP lasing of papilloma (total of 71 J at 30 Watts 15 msec pulses 2 pulses per second) with biopsy (resection)
Preop Diagnosis: Dysphonia with recurrent laryngeal papillomatosis
Postop Diagnosis: Same
Anesthesia:
Premedication with glycopyrrolate 2 mg taken orally two hours before the procedure
Valium 5 mg taken orallly 1/2 hours before remainder of anesthesia below
Bilateral superior laryngeal nerve blocks employing 1 cc of 2% lidocaine with 1:100,000 epinephrine to each side total of 2 cc
Bilateral glossopharyngeal nerve blocks 1 cc of 2% lidocaine with 1:100,000 epinephrine to the anterior base of the tonsillar fossa bilaterally (anterior tonsillar fold base) total of 2 cc delivered, then after waiting 10 minutes, repeated
1 cc of 4% lidocaine with 1% phenylephrine spray to left nostril ; followed by topical lidoaine/epinephrine on cottonoids placed intranasally
2 cc of topical 4% lidocaine administered through the working channel of the Olympus VT scope placed in the left nostril employing a 25-gauge sclerotherapy needle to the larynx and between the vocal cords the upper trachea
It is noteworthy this anesthesia was very effective in addressing cough gag and other movement which were negligible during this procedure but were substantial during others in this patient without similar preparation
Description of Procedure:
Following identification the patient informed consent and a brief timeout in the minor room in a sitting position with the eyes protected at all laser precautions observed the VT scope was placed in the left nostril with the sclerotherapy needle in place photographs were taken and anesthesia administered the scope was withdrawn and then the KTP laser fiber was preloaded into the VT scope and then placed through the nostril with
30 Watts 15 msec pulses 2 pulses per second
38 Joules (KTP 4 mode) anterior commissure immediately subglottic and on right anteriorly
33 joules (KTP V, 1,2 mode) to right vocal cord
Debulking was then performed with biopsy forceps through the Olympus flexible VT scope transnasally
F/U targetted in 6 months with understanding that he may call for earlier f/u if needed.
References
Eigsti RL, Bayan SL, Robinson RA, Hoffman HT. Histologic effect of the potassium-titanyl phosphorous laser on laryngeal papilloma. Laryngoscope Investig Otolaryngol. 2019 Feb 14;4(3):323-327. doi: 10.1002/lio2.250. PMID: 32025568; PMCID: PMC6997934.
Sabotin RP, Hoffman MR, Van Daele DJ, Stegall H, Hoffman HT. Modified sclerotherapy needle catheter as protective sheath for laser fibre passage in channelled flexible laryngoscopes. Clin Otolaryngol. 2024 Mar;49(2):287-290. doi: 10.1111/coa.14136. Epub 2023 Dec 30. PMID: 38158870.
Sullivan CB, Peterson J, Hoffman H. Optimal positioning to image the subglottis during transnasal flexible laryngoscopy. Clin Otolaryngol. 2018 Jun;43(3):979-980. doi: 10.1111/coa.12945. Epub 2017 Aug 8. PMID: 28736878.