OtoRhinoLaryngology Portal

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Post-Intubation Granuloma- Rigid Endoscopy Evaluation

                        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] 

Granuloma Complicating Voice Abuse & Hard Glottal Attacks



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.

Post-Intubation Granuloma

Left-sided granuloma comprising of mixed pale and pinkish hue with evidence of bruise complicating trauma which occurs upon vocal fold adduction.

Post-Intubation Granuloma with Right True Vocal Folds Fibrin & Bilateral Vocal Process Ulcerations

Partly hidden granuloma and the posterior commisure made fully visualized by pushing the endotracheal tube anteriorly using the tip of laryngoscope.

Vocal Process Granuloma- Intraoperative


                    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.

Vocal Process Granuloma Removal by Using "Cold" Instruments

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

Excision of Granuloma by Using Laryngeal Snare Device

 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.


Vocal Process Granuloma Removal by Using Laryngeal Snare @ YouTube

Pyogenic Granuloma


Pus discovered during endoscopic examination.

The flesh-red irregular granuloma arising from the posterior half of right vocal cord.

HPE confirms pyogenic granuloma.

CO2-Laser Excision of Pyogenic Granuloma

Pre-CO2 laser excision.




Post-CO2 laser excision.