At rest Upon phonation
Bilateral, small vocal process granulomas.
Established pedunculated benign granuloma complicating endotracheal intubation injury. The patient presented with hoarseness and episodic dyspnea. No stridor present. The lesions developed at its typical site - posterior glottis corresponding to the medial surface of the arytenoid cartilage. [1 - granuloma of right side, 2 - granuloma of left side, arrow - the stalk/pedicle, t - true vocal fold, f - false vocal fold, e - epiglottis]
Established left vocal process granuloma complicating voice abuse and hard glottal attack from intractable bouts of coughing in a patient who also has reflux laryngitis.
Left-sided granuloma comprising of mixed pale and pinkish hue with evidence of bruise complicating trauma which occurs upon vocal fold adduction.
Partly hidden granuloma and the posterior commisure made fully visualized by pushing the endotracheal tube anteriorly using the tip of laryngoscope.
Before Surgery After Surgery
Excision of this lesion by using cold instruments
is the preferred method rather than laser.
Excision of granuloma by using laryngeal snare
which is suitable for pedunculated or those with a well-defined pedicle.
Medial traction of granuloma showing its pedicle. Micro-scissors used
to cut as close possible to the pedicle base including the unhealthy mucosa.
Brisk bleeding controlled with temporary packing of adrenaline 1:1000
Inset image shows the close-up view of snare wire loop.
Figures show a technique used for removal of left-sided granuloma complicating radiofrequency posterior cordectomy by using laryngeal snare device. Venturi ventilation was utilized to avoid risk of accidental avulsion and aspiration if endotracheal intubation used instead. It also gives more room for instrumentations (endoscope, snare device, and tissue holding forceps). Homeostasis was
secured with topical 1:1000 adrenaline.