T. Shankar, Benjamin Rajendra Kumar. “Use of Powered Instrumentation in Microlaryngeal Surgery: A Clinical Study”. Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 86, October 26;
Page: 14965-14972, DOI: 10.14260/jemds/2015/2125 ABSTRACT: Micro laryngeal surgery is a common and relatively safe ENT surgery, certain laryngeal conditions require surgery for correction. Surgery for voice problems is quite uncommon, most of the voice disorders can be treated with voice therapy or medical treatment. However there are certain conditions may required operative measures. We have been doing micro laryngeal surgery(MLS) in our institute for quite a long time, but use of powered instruments like, microdebrider technique in MLS have been increased in recent days. We are here discussing the advantages of powered instrumentation in MLS and merits and demerits over the conventional instruments, a comparative study in 40 cases was carried out in our institute. Endoscopic debulking of obstructive laryngeal tumors to obtain an adequate airway is traditionally done with cold steel instruments or carbon dioxide lasers, however that technological advances and an increase in the availability of microdebrider have made powered instrumentation a good alternative to cold steel and lasers in this application. XPS microdebrider technique is a safe, effective, and rapid method for debulking obstructive laryngeal tumors and other laryngeal lesions.
KEYWORDS: Laryngoscope, Microbebrider, Vocal cords, Micro laryngeal surgery, Voice therapy.
INTRODUCTION: MLS is a surgery for voice problems, most of the voice disorders can be treated with medications or voice therapy, however there are some conditions in which operative measures are necessary, early detection of pre-malignant and malignant conditions of the larynx may be the best method to improve patient quality of life and survival rates, MLS the Kleinsasser method (K-1962) was introduced in 1962 as a new procedure to diagnose laryngeal disease.
Vocal cord polyp is a commonest benign lesion, hyperplastic well – defined lesion, normally located on the two anterior thirds of the vocal folds. It can be pedunculated or sessile and pale or reddish in colour, next followed by vocal cord nodules and papillomatosis, reinke’s oedema, chronic laryngitis and tuberculosis. The aim of this study is to show our results with microbebrider v/s Co2 laser and cold steel instruments in MLS surgery.
ANATOMY OF LARYNX: The larynx is situated in the anterior neck and is a protective sphincter at the inlet of the tracheo-bronchial tree. It extends from the hyoid bone above to the cricoid cartilage below, posterior part of the larynx projects in to the hypopharynx and forms the anterior wall of the hypopharynx.
The laryngeal cavity is divided for clinical purposes in to 3 major compartments:
Supraglottis: The space above the upper surface of the true vocal cords to the laryngeal inlet is the Supraglottis, laryngeal inlet is a part of the supra glottis and is formed by:
Free margins of the epiglottis.
Aryepiglottic flods, that extend laterally from the arytenoid cartilage to the epiglottis anteriorly.
Upper part of arytenoids and interarytenoid notch.
Just above the true cards but below and medial to the AE folds are two projections known a false vocal cords, the potential space between the true and false cords is called the ventricle. The ventricle contains numerous mucous secreting glands, which constantly lubricate the vocal cords.
GLOTTIS: The glottis begins from the superior (Upper) surface of the two true vocal cords superiorly and extends to 1cm below the free margin of the vocal cord inferiorly.
Fig. 1: Anatomy of Larynx Fig. 2: Coronal Section of the Larynx Showing
03 Major Sub Divisions The true vocal cords appear pearly white in colour and contains the vocal ligaments, which in turn are the thickened medial edges of the thyro-aryteniod muscles. The two vocal cords meet anteriorly and are attached to the inner surface of the thyroid cartilage at about the level of the thyroid prominence(Adam’s apple) this attachment is called the anterior commissure, the space in between two vocal cords is known as ‘rima glottis’ this is the narroyest part of entire upper airway in adults.
Posteriorly the two vocal cords separate from each other giving it a v-shaped appearance, called posterior commissure. The posterior 1/3rd of the vocal cord is formed by the cartilaginous vocal process of the arytenoid, while the anterior 2/3rd is formed by the vocalis muscle, both the arytenoid and vocalis muscle are covered by mucosa.