About Video

In this video clipping, the authors have demonstrated the use of a microdebrider/tissue-shaver in the treatment of exophytic laryngeal papillomatosis under general anesthesia. A laryngeal skimmer blade is used for this. An alternative is the laryngeal tricut blade. The advantage of using powered instruments for such a condition is evident in cases of florid papillomatosis, where the bulk of the lesions can be dramatically and rapidly reduced, effectively decreasing the time for surgery. The added advantage of simultaneous suctioning allows for the blood and debris to be evacuated immediately, thereby maintaining the visual field as well as preventing the latter to trickle into the distal airway and cause ‘seeding’ of the papillomas. Often, surgeons use a combination of modalities, such as the powered instruments/LASER/cold steel instruments to tackle these lesions. One must be careful of papillomas at the anterior commissure as their removal can lead to scarring and webbing, with a resultant poor vocal outcome. In such a condition, one may either leave the anterior commissure papillomas for a second stage, or treat one cord first, right upto the anterior commissure, and the other at a deferred stage (maybe a week or ten days later). The powered instruments should be set at 1200 to 1500 rpm so as to avoid excessive epithelial stripping of the delicate vocal folds.