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.

Infected Epiglottic Cyst Presenting With Stridor in an Adult: A Case Report

Epiglottic cyst is a benign tumour that can occur at all ages. Considering that the diameter of the respiratory tract is smaller in infants and children, an epiglottic cyst may easily obstruct the airway and large cysts may present as stridor, cyanosis with feeding and respiratory difficulty. On the other hand most adult epiglottic cysts remain benign and asymptomatic. Rarely they may progress to epiglottitis or epiglottic abscess, leading to airway obstruction and respiratory arrest. We report the case of a 20 year old male patient who presented to us with abrupt onset of dyspnoea and stridor. Our foremost priority was to secure the airway and emergency tracheostomy was done. Laryngoscopic examination revealed a large cyst occupying lingual surface of epiglottis including the free margin. Contrast enhanced CT scan of neck demonstrated prominent epiglottis with hypodense lesions suggestive of abscess within it. The patient underwent microlaryngoscopy with marsupialization of the cyst wall. Patient was subsequently decannulated and on follow up showed no recurrences of cyst.

Desflurane accelerates emergence after self-retaining laryngoscope under the microscope in the surgery of vocal cord / 复旦学报（医学版）

Objective To evaluate the effect of desflurane on emergency in patients undergoing suspension microlaryngoscopy surgery.Methods Forty adult patients with ASA Ⅰ-Ⅱ who underwent elective microlaryngoscopy surgery were randomly divided into desflurane group (group D,n =20) and sevoflurane group (group S,n =20).Time from end of the surgery to resume of spontaneous breathing,extubation,and discharge from postanesthesia care unit (PACU) were recorded.The extent of cough reflex during extubation and cough episode after extubation were recorded.Perioperative mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia induction (T0),on suspension laryngoscope instrument (Ttary),the gas concentration reached 1.3 MAC (T1.3mac),1 min after 1.3 MAC (T1.3 1),on arrival at PACU (Tpacu),on extubation (Textu),1 min after extubation (T 1),5 min after extubation (T 5),and on discharge from PACU (Tdis).Results Time from end of the surgery to resume of spontaneous breathing was not significantly different between the two groups.Time to extubation in group D was 4.6 min,which was shorter than it was in group S (P＜0.05).Time to discharge from PACU was 5.0 min in group D,which was shorter than it was in group S (P＜0.05).Incidence of cough was 100％ in group D and 55％ in group S during extubation (P＜0.05).The episode of coughing after extubation was not significantly different between the two groups.Perioperatively,changes of MAP and HR between the two groups were not significantly different (P ＞ 0.05).Conclusions Desflurane for adult patients undergoing suspension microlaryngoscopy surgery was associated with fast emergence.The incidence of cough was higher in group D than it was in group S during extubation,but it continued a short duration.

Efficacy of microlaryngoscopy radiofrequency in treatment of patients with tongue base cysts / 中国内镜杂志

Objective To investigate the clinical efficacy of microlaryngoscopy radiofrequency in treatment of patients with tongue base cysts. Methods 42 patients with tongue base cysts from January 2013 to December 2014 were randomly divided into treatment group and control group, the treatment group underwent microlaryngoscopy radiofrequency treatment, the control group underwent direct laryngoscopy under the tongue cystectomy, then the operation time, blood loss and postoperative recurrence rate were observed and recorded, and self-evaluation method using visual analog (VAS) to evaluate the effect of surgery. Results The operative time of treatment group was significantly shorter, and the blood loss was significantly less than the control group, the difference between the two groups was statistically significant (P 0.05); 12 months, the recurrence rate was 28.57% in the control group, the treatment group, the recurrence rate was 4.76%, the difference between the two groups was statistically significant (P < 0.05); Preoperative VAS score of the two groups have no significant difference, while after surgery, the VAS scores' difference was statistically significant, even treatment group compared with the control group VAS scores after surgery was statistically significant (P < 0.01). Conclusion Microlaryngoscopy radiofrequency in treatment of tongue base cysts have advantages of significant efficacy, safe and reliable, It's worthy of clinical promoting.

Pingyangmycin Local Injection Under Suspension Microlaryngoscopy for Hemangioma at Laryngopharyngeal and Laryngeal in 22 Cases / 医药导报

Objective To study the therapeutic effect of pingyangmycin local injection under suspension microlaryngoscopy for treatment of laryngopharyngeal and laryngeal hemangioma. Methods The total of 44 cases of patients with laryngopharyngeal or laryngeal hemangioma were randomly divided into the experimental group ( n=22 ) and the control group (n=22). They were treated with bleomycin 5 mg or pingyangmycin 4-8 mg injection under suspension microlaryngoscopy in the hemangioma, respectively. If the treatments were not curative, repeated one more times in intermittent 15 d, but not more than 3 times. Therapeutic effect and adverse effect were recorded and analyzed. Results The total effective rate (95. 4%)in the experimental group was significantly better than that (59. 1%) in the control group (P<0. 05),and side reaction in two groups showed no significant variation. Conclusion Pingyangmycin local injection for treating laryngopharyngeal and laryngeal hemangioma is effective, less adverse reaction.