Consistent Technique Limits Suspension Laryngoscopy Complications

Abstract Introduction Suspension laryngoscopy (SL) is a commonly performed procedure among otolaryngologists. Several studies have shown that adverse effects occur regularly with SL. Objective To evaluate the postoperative complications of SL, and to determine if protecting the dentition and the oral mucosa and limiting suspension times decrease the overall incidence of oral cavity and pharyngeal complications of SL. Methods All of the cases of SL performed by 1 surgeon from November 2008 through September 2014 were retrospectively reviewed. A consistent technique for dental and mucosal protection was utilized, and suspension times were strictly limited to 30 consecutiveminutes. The incidence of postoperative complications was calculated and analyzed with respect to gender, smoking status, dentition, laryngoscope type, and suspension system. Results A total of 213 consecutive SL cases were reviewed, including 174 patients (94 male, 80 female). The overall postoperative complication rate was of 3.8%. Four patients experienced tongue-related complications, two experienced oral mucosal alterations, one had a dental injury, and one experienced a minor facial burn. The complication incidence was greater with the Zeitels system(12.5%) compared with the Lewy suspension system (3.3%), although it was not significant (p = 0.4). Likewise, the association of complications with other patient factors was not statistically significant. Conclusion Only 8 out of 213 cases in the present series experienced complications, which is significantly less than the complication rates observed in other reports. Consistent and conscientious protection of the dentition and of the oral mucosa and limiting suspension times to 30 minutes are factors unique to our series that appear to reduce complications in endolaryngeal surgery.

Therapeutic effect of pingyangmycin injection combined with hypercator resection under suspension laryngoscope on laryngopharyngeal hemangioma / 第二军医大学学报

Objective To observe the clinical effect of pingyangmycin injection combined with hypercator resection on laryngopharyngeal and laryngeal hemangioma under suspension laryngoscope. Methods Twenty-seven patients with laryngopharyngeal or laryngeal hemangioma were included. After trachea cannula via mouth and general anesthesia, the suspension laryngoscope was used to completely uncover the hemangioma, and 8 mg pingyangmycin (diluted with 6 mL saline injection) was locally injected into the tumor. And then the tumor was completely resected along its root by polypus forceps-like hypercator or was completely coagulated by electric coagulation. The intra-operative and post-operative bleeding were recorded, and the patients were given liquid diets after surgery for two weeks. The fibrolaryngoscope was reviewed to judge the curative effect at 1 month, 3 months, 1 year, 2 years, and 3 years after surgery. Results The pink or prunosus tumor turned into pinkish-white tumor after injection of pingyangmycin. When the root pedicle of the tumor was revealed by forceps holder, the polypus forceps-like hypercator could completely resect the tumor along the base of root, nearly without bleeding in the operation; when the root pedicle was big or could not be revealed, the tumor could be completely coagulated by electric coagulation. After surgery, no patients had dyspnea or wound bleeding. One month later, fibrolaryngoscope showed that the wound was repaired with pink normal mucosa. No recurrence was found in all cases after follow-up for 1 year. After 2 years of follow-up, one case had flaky purple uplift of the pharyngeal wall mucosa, and the tumor was completely resected by the above treatment. No recurrence was found after 3 years of follow-up. Conclusion Hypercator resection after local injection of pingyangmycin under suspension laryngoscope can completely resect the lesions, with less surgery trauma and quick recovery, suggesting that the treatment has affirmative efficacy and is worth popularizing.

Radiological Predictors of Difficult Laryngeal Exposure in Laryngomicrosurgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngeal microsurgery (LMS) is a common procedure for diagnosis and treatment of various laryngeal diseases. Sometimes, laryngeal exposure is poor and LMS may be impossible. The aim of this study was to investigate factors related to difficult laryngeal exposure in LMS. SUBJECTS AND METHOD: Three hundred patients who underwent LMS were enrolled in this study. The patients were categorized into 3 subgroups (easy exposure group, moderate exposure group, and difficult exposure group) according to the glottic visualization under suspension laryngoscopy. The 14 parameters on lateral extension neck X-ray in the closed and open mouth view were analyzed to evaluate laryngeal exposure. RESULTS: The study included 168 males and 132 female patients with the mean age of 48.36+/-12.39 (10-79) years. Of 300 patients, 244 patients were classified as the easy exposure group, 41 as the moderate exposure group, and 15 as the difficult exposure group. Patients with difficult laryngeal exposure were significantly higher in males (p<0.001). Among 14 radiologic parameters, thyroid incisor angle in closed mouth view (p=0.003) and sternum-mentum distance in open mouth view (p=0.04) were significantly related with difficult laryngeal exposure on the multivariate analysis. CONCLUSION: Being a male, having a narrow thyroid incisor angle in the closed mouth view and having a short sternum-mentum distance in the open mouth view are useful patient indications that serve to predict difficult laryngeal exposure in LMS.

Severe bradycardia during suspension laryngoscopy performed after tracheal intubation using a direct laryngoscope with a curved blade: A case report / 대한마취과학회지

There are a few reports about bradycardia or asystole caused by direct laryngoscopy. However, we encountered severe bradycardia in response to suspension laryngoscopy for laryngeal polypectomy after safely completing tracheal intubation using a direct laryngoscope with a curved blade. The tip of the curved blade of the direct laryngoscope is positioned at the vallecula (between the base of the tongue and the pharyngeal surface of the epiglottis) during tracheal intubation, while the blade tip of the suspension laryngoscope lifts the laryngeal surface of the epiglottis or supraglottic area during surgery. Therefore, suspension laryngoscopy can be said more vagotonic than curved-blade direct laryngoscopy. Because of the possibility of bradycardia induced by suspension laryngoscopy, clinicians must be careful about severe bradycardia even after safely completing intubation using direct laryngoscopy.

Complicações da laringoscopia de suspensão / Complications of suspension laryngoscopy

Introdução: A laringoscopia de suspensão é um procedimento rotineiro com finalidades diagnóstica e terapêutica. Objetivo: avaliar as complicações desse procedimento e seu impacto no período de internação dos pacientes. Pacientes e Método: Foram estudados retrospectivamente 297 procedimentos realizados em 293 pacientes consecutivos entre 1.997 e 2003, sendo 64,64% do gênero masculino e com idade que variou de 6 a 82 (mediana, 37 anos). Um total de 23,3% dos procedimentos foi para diagnóstico e 76,7% para tratamento, enquanto 0,67% foi em laringe normal, 71,7% para lesão benigna e 27,6% para maligna. Instrumental frio foi utilizado em 99% dos pacientes e o laser de CO2, em 1,01%. Foram estudadas as complicações: dentárias; mucosas; em nervos; hematoma; hemorragia; e sistêmicas. As complicações foram divididas em maiores (com prolongamento da internação) e menores. Resultados: Lesões mucosas foram encontradas em 11,44% dos casos, sendo 8,75% ferimentos cortantes, seguido de hemorragia (1,68%) e hematoma (1,01%). O sítio mais acometido foi o ventre lingual (5,05%), seguido do lábio inferior (3,37%). Houve 2,69% de trauma dentário, 1,01% de parestesia temporária de língua, 1,01% de broncopneumonia pós-operatória e duas complicações maiores: broncoespasmo e broncoaspiração. Conclusão: A laringoscopia de suspensão é segura, com 16,48% de complicações, sendo 8,75% lesões mucosas.

Introduction: The suspension direct laryngoscopy is procedure routinely employed in diagnosis and treatment. Objectives: to evaluate its complications and the impact on the hospitalization time. Patients and methods: We retrospectively studied 297 procedures in 293 consecutive patients from 1997 to 2003. Out of 64.64% were males and the ages varied from 6 to 82 (median, 37). We performed 23.3% of the procedures for diagnosis and 76.7% for treatment, while 0.67% were in normal larynges, 71.7% in benign lesions and 27.6% in malignant lesions. Conventional cold instruments were used in 99% and CO2 laser in 1.01%. Dental injuries, mucosal lesions, nerve lesions, hematoma, hemorrhagia and systemic complications were studied. The complications were classified in major (when requiring a prolonged hospitalization) and minor. Results: Mucosal lesions were found in 11.44% of the patients, distributed in erosions (8.75%), hemorrhagia (1.68%) and hematoma (1.01%). The most commonly injuried sites were the ventral portion of the tongue (5.05%) and the lower lip (3.37%). Dental injuries were found in 2.69%, temporary lingual parestesia in 1,01%, and postoperative pneumonia in 1.01%. There were two major complications: one bronchospasm and one bronchoaspiration. Conclusion: The suspension laryngoscopy safe, with a complication rate of 16.48%, including 8.75% of mucosal lesions.

Continuous Measurement of Suspension Force during Suspension Laryngoscopy: Preliminary Report / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although suspension laryngoscopy is a very common procedure in the otolaryngoloical field and suspension force (Fs) is suspected to be related with the complications or laryngeal exposure, Fs has not been objectively measured yet. The objective of this study is to measure suspension force continuously during suspension laryngoscopy. SUBJECTS AND METHOD: Sixteen patients who had undergone laryngoscopic surgery were evaluated. The value measured with a load cell during the procedure was converted to Fs with calculation. The maximum force (Fsmax) and the mean force (Fsmean) were evaluated. The angle between the laryngoscope and the chest holder(angle alpha), and the angle between the chest holder and the horizontal plane (angle beta) were gauged. RESULTS: The mean values of Fsmax and Fsmean were 14.2 and 25.5 kgf, respectively. The mean values of angle alpha and angle beta were 124.0+/-4.3 degrees, and 19.0+/-2.6 degrees, respectively. CONCLUSION: The continuous measurement of the suspension force was executed successfully and quantitatively with a simple method.

Special treatment in anesthesia of laryngomicrosurgery under the suspension laryngoscopy / 重庆医科大学学报

Objective:To discuss the influence of different ways of anesthesia for surgery of vocal cord under laryngomicrosurgery.Methods:Forty ASA Ⅰ～Ⅱ patients undergoing surgery of vocal cord were randomly divided into two groups:Group Ⅰ ( n =20) received topical anesthesia of larynopharynx with 2% lidocaine 2ml before general anesthesia.Group Ⅱ ( n =20) received general anesthesia with topical anesthesia. Anesthesia was induced with 2% propofol 1～2mg/kg and fentanyl 100?g followed by vocuronium 0.1 mg/kg.The small-diameter Fr 6.0 trachea tube was intubated nasally.The lungs were mechanically ventilated.Anesthesia depth was maintained with 2.0 MAC isoflurance and propofol infusion 1～2mg/kg or discontinuous fentanyl.Dexamethasone was given at end of the procedure.ECG,HR,BP,S PO 2,P ET CO 2,blood gas were monitored during intubation,extubation or the microlaryngoscopy.Results:Cardiovascular reactions in Group Ⅰ were significantly less than in Group Ⅱ during intubation,extubation or placed microlaryngoscopy,and no complications occured in two groups.Conclution:Compared with topical anesthesia general anesthesia is a better method for surgery of vocal cord under laryngomicrosurgery.It can significantly relieve of cardiovascular effect and complication.