2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Annals of Otology, Rhinology & Laryngology 123(12)

Figure 1.  (A) Office laryngoscopy demonstrating a patient with a T2b N0 M0 squamous cell carcinoma of the right vocal fold that invaded the ipsilateral arytenoid, supraglottis, subglottis, and contralateral vocal fold. (B) Microlaryngoscopic examination of the tumor through the Universal Modular Glottiscope (Endocraft LLC, Boston, Massachusetts, USA) prior to removal. The airway was secured and interarytenoid exposure was obtained by using a Hunsaker jet-ventilation catheter (Medtronic Xomed Inc, Jacksonville, Florida, USA) rather than a conventional endotracheal tube. (C) The tumor removal began posteriorly on the arytenoid, and dissection was done until the deep portion of the tumor was removed to encounter normal paraglottic soft tissue. (D) The tumor removal proceeded anteriorly while carefully identifying the interface of malignant soft tissue with normal underlying residual thyroarytenoid muscle. Note the visible striations of the vocal muscle. (E) At the conclusion of the first of the staged procedures, there was limited carbonization of the residual underlying thyroarytenoid muscle. There was a small amount of tumor remaining on the medial surface of the contralateral left vocal fold. This disease was treated at a second stage approximately 6 weeks later. (F) Office laryngoscopy subsequent to reconstruction, which included a lipoinjection to expand the paraglottic region so that the neocord is convex. Thyroid lamina subluxation was also done to reconfigure the acute angle of the anterior commissure. (G) During glottal adduction, there was near-complete glottal closure with a small residual aperture noted posteriorly where a portion of the arytenoid had been removed. (H) During stroboscopy, a well-delineated phonatory mucosal wave was generated in the left vocal fold, demonstrating the outstanding pliability of the phonatory mucosa extending directly into the anterior commissure. The right neocord, which has no superficial lamina propria, remains in the midline as a contact surface but is incapable of vibration.

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