A- dissector ball end, B- hook, C- angled elevator,
D- curved elevator, E- needle sharp pick,
F- curette oval spoon, G- lancet knife, H- sickle knife, I- round knife.
Sataloff Laryngeal Injection Needles set by Medtronic Xomed. These fine tip needles can be used for intralesional therapeutic injection such as triamcinolone for scar, subepithelial saline infusion with or without adrenaline in benign laryngeal pathology, and cidofovir injection for recurrent respiratory papillomatosis.
Nicely exposed operating field which allows an excellent microscopic view and unrestricted bimanual instrumentations.
Poorly exposed operating field with hidden anterior commissure. The polyp (+) has a broad base attached to right vocal fold free border. Repositioning of the laryngoscope tip, the use of vocal fold retractor device, and external cricoid pressure would give the exposure required.
Benign left vocal fold polyp before and after endolaryngeal microsurgery.
Figure A Figure B
Figure C Figure D
Figure E Figure F
Figure G Figure H
Figure A: Good exposure obtained preferably by using an anterior commissure laryngoscope with adequate internal diameter to allow bimanual instrumentation without crowding the operative view. Vocal fold retractor may need to be used and cricoid pressure applied if necessary.
Figure B: Firm grasp of polyp with soft medial traction to enable the base of the polyp to be seen clearly.
Figure C: Excising the polyp by using a suitable microlaryngeal scissors, curve-to-right for this left-sided polyp.
Figure D: Transient bleeding is to be expected as shown.
Figure E: Topical application of adrenaline for homeostasis. This may be repeated few times.
Figure F: Remains of polyp can be seen if any and need further removal. Do not over-excised and know when to stop!
Figure G: View just before the vocal fold retractor removed.
Figure H: View at completion of surgery before the patient extubated.
Immediate voice improvement is rewarding for the patient and wait for the official histopathological report before concluding the diagnosis.
[Pantai ENT Laser & Voice Centre, Pantai Hospital Cheras, Kuala Lumpur, MY]