Atlas of Phonomicrosurgery Nupur Kapoor Nerurkar
INDEX
Page numbers followed by f refer to figure.
A
Abduction 120f
Aberrant blood vessels 151f
Acid-fast bacilli 127
AcuBlade 10, 16, 17f, 21f, 34, 35f
CO2 laser 26f, 31f, 40f, 67f, 76f, 87f, 92f, 108, 125f
Adductor 91
Airway balloon catheter 142f
Amyloid 116, 118
Amyloidosis 116, 117, 118f
classification based on type of protein 116
amyloid-associated 116
A beta 116
amyloid light-chain 116
Symmer's classification 116
amyloid associated with multiple myeloma 116
hereditary or familial amyloid 116
primary amyloid 116
secondary amyloid 116
Anchoring fibrils 3f
Anesthesia 14, 59f
general 119f
Anterior commissure 125f
disease 106f
Antinuclear antibody 119
Antitubercular treatment 134f
Arm rest 8
Arytenoid 2f
Aspergillus 123
infection of larynx 124f
Atlanto-occipital joint 13
B
Bamboo nodes 99
Basement membrane
cells 7
zone 66
Bence Jones proteins 119
Blastomycosis 123
Blood urea nitrogen 118
Blue-gray backdrop 82f
Bone marrow biopsy 119
Botulinum toxin 95f
Bouchayer forceps 17f, 21f, 22f, 125f, 157f
Bronchoscopy, telescopic 133f
Broyles’ tendon 3
C
Candida albicans 123
Candidiasis 125f
Carbon dioxide laser excision 138f
Carcinoma in situ 150f
Carpet-like growth 151f
Chalky plaque, bilateral 128f
Coccidioimycosis 123
Cohen's classification 69
type 1 69,70
small glottic webs 69
type 2 69, 70, 71
congenital, anterior glottic web 71
iatrogenic web 72
malignant 73
traumatic, anterior glottic web 74
type 3 69, 70, 73
congenital, anterior glottic webs 73,76, 77
type 4 69
Cold steel instruments 8, 9
Collagen fibers 7
Commissure disease
anterior 106f
posterior 107f
Complete blood count 118, 127
Complete cyst excision 43f
Concurrent laryngeal tuberculosis 128f
Congestion 131f
Contact granuloma 90, 91, 95f
Farwell classification of 91
Contact lesion 125f
Conventional biopsy 105f
Conventional phonomicrosurgery instruments 9
Cord 1
Cordectomy 149
types of 149
Cotton pledget 14, 16f, 32f
Cricoarytenoid joint 99
fixation of 99
Cyst 23f
anterior retraction of 32f
cold steel dissection of 23f
collapse of 41f
contents, aspiration of 41f
epithelial attachment of 33f
epithelium of 39f
excision of 35f
inspection of 38f
laser excision of 43f
lining columnar epithelium 30
lining stratified squamous epithelium 30
open 28, 28f
palpation of 30f
posterior dissection of 33f
removal of 7f
right bilobed 39f
rupture of 38f
subepithelial 41f
D
Dedo laryngoscope 13
Dennis and Kashima's posterior laser cordotomy 143
Derkay-Coltrera staging system 104
Dikkers staging system 104
Dilated subepithelial vessels 25f
Distal tracheal papillomas 113f
Dysphonia 117
Dysplasia 89f
Dyspnea 117, 120f
E
Early glottic malignancy 149
Echocardiography 119
Endoscopic keel placement 76f
Endotracheal tube 1f, 63f, 113f
Epidermoid cyst 29f, 30f, 36f
open 29f, 35f
single 56
Epiglottis, lingual surface of 150f
Epithelial
cordotomy 16f, 21f, 31f, 33f, 37f, 39f, 48f, 64f, 125f
anterior extension of 31f
completion of 16f, 128f
flap 7f, 125f
elevation of 7f
lesion 125f
microflap, anterior excision of 128f
mucosal bridge, left thin 56f
Epithelium 3f, 50f, 152f
erythroplastic 128f
Erythema 123f, 126f
Erythrocyte sedimentation rate 118
Erythroplasia 127f
Esophagus 149
Exophytic RRP
multifocal 104
unifocal 104
F
Farwell grade 91
Fatty acids 47f
Fibrotic band
anterior 30f, 31f, 33f, 40f, 43f
posterior 30f, 31f, 33f, 37f, 40f
Fibrovascular core 103f
Filament, higher density of 3
Fine-needle aspiration 119f
Flexible
laryngoscopy 139
laryngostroboscopy 145
Fluconazole 126f
Focal necrotizing glomerulitis 139
Fungal
culture 133
laryngitis 91, 123
plaques 81
tests 133f
G
Gastroesophageal reflux disease 62
Gauge infiltration needle 9f
Globose vesicle 124f
Glottic
excision, complete right 84f
keratosis, excision of right 82f
malignancy, TNM staging of 149t
soft tissue thickening 117f
subepithelial cysts 28
web 69
anterior 80f
small 69
Glottis
posterior 4
pseudostratified ciliated epithelium, posterior 1
Granuloma 92f, 131f
complete excision of 94f
formation 146f
larynx 90
laser excision of pedicle of 92f
medial retraction of 94f
retraction of 95f
right vocal fold 94f
toto removal of 95f
Granulomatosis 139
Gum-elastic-bougies 140f
H
Heat sink 8
Hemorrhagic
cyst
excision, right 6f
right 6f, 23f
polyp 15f
bilateral 18f
large right 25f
left 20f, 26f
right 59f
Hemostasis 8
Hiltons pouch 2
Hirano's cover-body theory 2
Histoplasma 123
Human papillomavirus 101, 102
infection 150
vaccination 105
Hydrodissection 8
Hydrostatic distention 8f
Hyoid bone, level of 98f
Hypoglossal paresis 14
I
Infant feeding tube 76f
Inflammatory infiltration, chronic 90
Infraglottic
epithelium 8f, 17, 18f, 23f, 58f
epithelium, dissection of 17f
incision 65f
swelling 122f
Internal carotid artery 97f
Invasive squamous cell carcinoma 150f
mid-membranous 155f
J
Juvenile-onset recurrent respiratory papillomatosis 101
K
Kashima's cordotomy 144146, 147f
Keratinized stratified squamous epithelium 103f
Keratosis 81
anterior 83f
management of 81
Keratotic growth 156f
Kissing polypoidal nodules, bilateral 67f
Kleinsasser laryngoscope 13
Koilocytes 102
L
Lamina propria, superficial 3, 3f, 5, 7f, 8, 8f, 15, 28, 62, 152f
Laryngeal
amyloidosis 116, 117f
aspergillosis 124f
blades 8
candidiasis 123f, 127f, 128f, 129f
electromyography 99
infusion 8
lipomas 96
tuberculosis 130, 131f
primary 132f
ventricle 2f
webs 69
Laryngopharyngeal reflux 91
Laryngoscopy 119f, 120f, 122f
postoperative 121f
Laryngostroboscopy 98f
Larynx 90
gray-blue backdrop of 83f
lipoma of 96
normal 2f
suturing in 10f
Laser 10
ablation 106f, 107f
endotracheal tube 113f, 133f
epithelial cordotomy 22f, 23f, 26f, 65f, 128f, 154f
excision 121f
microflap excision 84f
phonomicrosurgery 8
safety 14
tube in situ 63f
with scanning system 8
Left anterior commissure 114f, 117f
intact mucosa 88f
Left crocodile forceps 35f, 38f, 60f
Leukoplakia 81
Lipoma 96, 98f
M
Macula flava
anterior 1f
right 2f
Mallinckrodt laser tube 15f, 22f
Mayos trolley 8
Medial pyriform sinus 135f
Microflap
excision, left 128f
incision
thicker lateral 6f
thinner medial 6f
sickle 9f
Microlaryngoscopy 12
chair 8
technique of 12
Mini-microflap 7
Mitomycin C 141f
Morgagni's sinus 2
Mucosal
bridge 56, 56f
ulceration, superficial 90
Mucous gland, blockage of duct of 30
Mucous retention cyst 29f, 30, 30f
Multilobulated massive contact granuloma 92f
Multinucleated giant cells 124f, 131f
Multiple myeloma 116
Mycobacterium tuberculosis 130
Myxomatous polyp 19f
N
Neck, soft tissues of 149
Necrotizing granulomatosis 139
Neurofibromatosis 135
Nodules 66
P
Pachyderm 4
Papilloma 101f, 103f, 106f, 109f, 112f
carpet of 106f
Phonomicrosurgery 5, 9, 12
instruments 9f
powered instruments in 10
principles of 5
Phonosurgery 5
Phonotrauma 30
Plaque 125f
Plexiform neurofibromas 135
Polyangiitis 139
Polyp 17f
laser excision of 22f
Polypoid corditis
left 64f, 65f
right 65f
Proton pump inhibitor 91
Puberty 105
Pulmonary tuberculosis, treatment for 57f
Pyogenic granuloma 90f
R
Recurrent respiratory papilloma 101, 115
staging of 104
Red rubber tube 14
Reinke's edema 8, 62, 62f, 63f
grades of 62
Reinke's space 34
Rheumatoid arthritis 99
laryngeal manifestations 99
factor 119
S
Serum glutamic oxaloacetic transaminase 118
Serum glutamic pyruvic transaminase 118
Sessile growth
multifocal 104
unifocal 104
Sickle knife 21f
Silastic keel in situ 77f
Slit epithelial loss 20f
Soft tissue lesion 97f
Squamous cell carcinoma 81, 115f, 151f, 153f, 156f, 157f, 159f
invasive carcinoma 87f
Strap muscles 149
Stroboscopic evaluation 1
Stroboscopy 117f
Subepithelial
cordectomy, right 153f
cyst 28, 30f, 32f, 36f
left 28f, 37f
right 40f, 43f, 61f
types of 28
disease, diffuse 117f
infiltration 16f, 124f
advantages of 8
ballooning 152f
left 22f
technique 8, 8f, 41f, 82f, 154f, 156f
methylprednisolone 140f
vessels 19f
Subglottic
airway 78f
extension, anterior 77f
stenosis 139
Subglottis 138f
Sulcus 45
physiological 45, 45f
vocalis 46
Supraglottic homogenous hypodense fat density mass 98f
Symptomatic laryngeal lipomas, management of 96
Syphilis 90
T
Thyroarytenoid 1
muscle 91, 95f
Thyroid 149
cartilage 98f, 147f, 149
destruction 117f
inner perichondrium of 144f
Tooth protection guards 8
Trachea 149
Tracheal papillomas 113f
Tracheostomy 104
tube 138f
Transmuscular cordectomy 159f
Transoral laser microsurgery 149
Tricut laryngeal microdebrider 106f
Tuberculin skin test 119
Tumor 156f
U
Urine
analysis 119
immunoelectrophoresis 119
V
Vacuolated cells 103f
Vallecular cyst 40f
Ventricular cyst, left 42f
Vibrating edge 22f
Vibration 1
Vicryl threads 80f
Vocal fold 8f, 19f, 65f, 85f, 100f, 123f, 126f, 133f
anterior keratosis of left 85f
bilateral 132f
keratosis of true 81f
bulging of left 48f
carcinoma in situ of 149, 153f
complete, right 110f
congestion 133f
left 127f
right 131f
cordectomy of left 156f
cut, false 144f
cyst 28
ligament 28
ectasia, left 41f
edge, right 73f
epithelium, right 74f
eversion of left 32f
false 2, 117f, 119f, 144f147f, 150f
fixation, tumor limited to larynx with 149
ipsilateral 91
irregular 158f
keratosis, right 83f
left 20f, 23f, 28f, 36f, 54f, 57f, 60f, 64f, 73f, 84f, 85f, 106f, 111f, 126f, 156f
false 1f, 121f, 145f
posterior 151f
true 145f
vocal process from 145f
lesion 152f
medial edge, left 75f
microscopic anatomy of 1
mid membranous 15
mobility 149
multilayered anatomy of true 2
nodules 66
normal 152f
palpation of 57f, 59f, 126f
paralysis, bilateral 143
polyp 15
diagnosis of right 93f
left 49f
posterior part of 84f
postoperative of 32f
structure, age- and gender-related differences in 4
sulcus 45
medial lip of left 35f
true 1f, 2f, 99, 133f, 144f, 146f, 150f
ulcer, left 88f
vascular lesions, left 27f
vibrating edge of 32f
Vocal fold separator 73f
Vocal ligament 6f, 79f, 152f, 155f, 158f
Vocalis muscle 155f
Voice quality 86f
W
Web incision 74f
Wegener's granulomatosis 139
White flaky plaques 126f
Z
Zeitels universal modular glottiscope 134
×
Chapter Notes

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Atlas of PHONOMICROSURGERY
Atlas of PHONOMICROSURGERY
Author Nupur Kapoor Nerurkar MS (ENT) DORL Laryngologist and Voice Surgeon DNB Coordinator, ENT Department Director, Laryngology Fellowship Program Bombay Hospital and Medical Research Center Governing Council; Association of Phonosurgeons of India Forewords Marc Remacle Milind V Kirtane
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Atlas of Phonomicrosurgery / Nupur Kapoor Nerurkar
First Edition: 2018
9789352702244
Printed at
I dedicate this book to my parents, my children—Kanika and Anaaya, and my husband Rajeev, with love
Foreword
It is my pleasure and honor to have been asked to write the foreword for this “Atlas of Phonomicrosurgery,” written and edited by Professor Nupur Kapoor Nerurkar.
I have known Nupur for some years now and have also had the privilege to take part in some of her well-established courses on laryngology. From our first meeting, I have been impressed by her knowledge of the anatomy, physiology, and pathology of the larynx.
The larynx is a very complicated organ. Beside its major functions—voicing, swallowing, and breathing—it contributes to the expression of our emotions and feelings. This is why phonosurgery and, in particular, phonomicrosurgery is so complicated to master, as the entire personality of the patient is contained in the production of their speaking and singing voice. The phonosurgeon must understand not only the etiology and management of the dysphonia but also must anticipate what the patient expects from their voice after the surgical treatment. This goes far beyond the capacity of performing only a good procedure. There is no doubt in my mind that Dr Nupur Kapoor Nerurkar masters all these aspects of phonomicrosurgery.
This atlas is another demonstration of Dr Nerurkar's teaching prowess. What you have in the hands is much more than a basic atlas with the usual pictures illustrating the various pathologies of the larynx and the vocal folds. This atlas encompasses the microscopic and histological aspects of the vocal fold lesions, the principles of phonomicrosurgery, the tips and tricks for difficult scenarios, and safety during laser use and anesthesia. The subsequent chapters are a comprehensive review of phonomicrosurgery specific to the different lesions. Not only is there a systematic presentation of what must be done but also how to do it step by step according to the pathology. The two major techniques performed today—cold steel and carbon dioxide laser phonomicrosurgeries—are described, emphasizing advantages and disadvantages of each of them.
If this was necessary, this atlas gives us another reason why Dr Nupur Kapoor Nerurkar is a leading phonosurgeon, well-recognized not only by her patients and colleagues in India, but also all over the world.
Professor Marc Remacle MD PhD
Department of ORL-Head and Neck Surgery, Voice and Swallowing Disorders
CHL-Eich
Luxembourg, Luxembourg
Foreword
Laryngology as a subspecialty of ENT has gained considerable importance over the last decade. With advanced diagnostic techniques and refinements in operating equipment, treatment of patients with voice disorders has undergone a sea change.
The author of this atlas, Dr Nupur Kapoor Nerurkar, is a renowned laryngologist who has received recognition in the field of laryngology and phonosurgery not only in India, but also internationally.
The workshops on phonosurgery conducted by her yearly have proved to be a great learning experience for not only budding phonosurgeons but also for all ENT surgeons who encounter patients with voice disorders in their day-to-day practice. This atlas details a step-by-step approach depicted by high quality photographs which encompass diagnostic, surgical, and histopathological aspects of phonosurgery.
I am confident that the readers will vastly benefit from the comprehensive knowledge gained through this atlas.
Dr Milind V Kirtane
Professor Emeritus
King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College
Mumbai, Maharashtra, India
Acknowledgments
This atlas is an amalgamation of the work I have had an opportunity to do at the Bombay Hospital and Medical Research Center over the past 10 years. I thank my patients for the opportunity to serve them and their faith in me.
I am extremely grateful to Mr Bharat Taparia, the Chairman of Bombay Hospital and the management team for supporting a state-of-the-art laryngology setup, conducive to optimal patient management, teaching, and archiving of data.
The Departments of Anesthesia, Histopathology, and Radiology have been incredibly helpful and cooperative. I thank Dr P Kulkarni, Dr JP Arora, Dr G Mujumdar, Dr K Patel, Dr I Talwar, Dr S Jaggi, and Dr S Shah in particular. All my colleagues in the ENT and Speech Language Pathology Departments of Bombay Hospital have been supportive, especially Dr R Nerurkar and Dr S Muranjan. The Association of Phonosurgeons of India (APSI) has encouraged all my academic initiatives and I thank my APSI colleagues for the same.
The assistance provided by all my laryngology fellows and residents over the years has been a huge help in getting this atlas to see the light of day and the operating theater staff could not have been more accommodating.
I am indeed fortunate to have learnt from many laryngologists all over the world and I hope to be able to teach as generously as I was taught. Professor Marc Remacle has not only been an amazing teacher for me, but also someone who has always encouraged me in my endeavors, and I am honored that he has written a Foreword to this book.
Finally, I would like to thank the person who is integral to the birth of this atlas, my mentor, Professor Milind V Kirtane.
Nupur Kapoor Nerurkar
Abbreviations AKT
Anti Kochs treatment
AORRP
Adult onset recurrent respiratory papillomatosis
BLVFP
Bilateral vocal fold paralysis
BMZ
Basement membrane zone
CC
Clara chroma
CO2
Carbon dioxide
CT
Computed tomography
DNA
Deoxyribonucleic acid
E
Endoscopic
ESR
Erythrocyte sedimentation rate
H&E
Hematoxylin and eosin
HD
High definition
HPV
Human papillomavirus
JORRP
Juvenile-onset recurrent respiratory papillomatosis
KOH
Potassium hydroxide
KTP
Potassium titanyl phosphate
M
Microscopic
MLS
Microlaryngoscopy
NBI
Narrow Band Imaging
NF1
Neurofibromatosis type 1
OT
Operation theater
PNS
Peripheral nervous system
RA
Rheumatoid arthritis
RL
Rigid laryngoscopy
RRP
Recurrent respiratory papillomatosis
SA
Spectra A
SB
Spectra B
SEC
Subepithelial cyst
SEH
Subepithelial hemorrhage
SEIT
Subepithelial infiltration technique
SLP
Superficial lamina propria
TB
Tuberculosis
TLM
Transoral laser microsurgery
URTI
Upper respiratory tract infection
VLS
Videolaryngoscopy
WL
White light