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
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