LASER arytenoidectomy
by Philippe Monnier T, Philippe Vicky S, Philippe Bachi T

Jaypee’s Video Atlas of Operative Otorhinolaryngology AND Head & Neck Surgery

by Vicky S Khattar, Bachi T Hathiram
About Video

Here a partial arytenoidectomy using the CO2 LASER has been demonstrated in a patient of bilateral vocal fold immobility. This helps to widen the posterior glottis, thus enhancing the airway adequately for respiration, yet simultaneously ensuring that aspiration does not occur. Despite preservation of the membranous vocal fold, there is always a certain degree of trade-off with the voice. The first step is to detach the membranous vocal fold from the vocal process. Then a mucosal flap on the medial surface of the arytenoid is elevated, preserved and subsequently draped over the defect, thus ensuring rapid healing and preventing posterior glottis stenosis. The vocal process and body of the arytenoids is then ablated with the LASER to enlarge the airway. Once that has been done, the flap is draped and secured with the use of fibrin glue to allow for a muscosa-covered posterior glottis, thus reducing the chance of restenosis and scarring. The temporary use of the balloon of the endotracheal tube can be used to hold this mucosal flap in place till the fibrin glue sets.

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