Laryngology laryngeal surgery Flashcards
(35 cards)
What size ETT should be used during laryngeal
surgery?
The smallest ETT that will allow adequate ventilation and is
long enough to extend from the lips to the subglottis
What are the four most common ventilation
techniques used during laryngeal surgery?
● Endotracheal intubation
● Jet ventilation
● Spontaneous breathing
● Apneic technique
What are the three types of jet ventilation?
● Supraglottic
● Subglottic
● Transtracheal
What is the most common major complication of
subglottic jet ventilation?
Air trapping leading to pneumothorax/pneumomediasti-
num
What physical examination findings may be associated with difficult endotracheal intubation?
Long incisors, retrognathia, poor mandibular protrusion,
small interincisor distance, Mallampati grade 3 or 4, high
arched palate, short neck, thick neck, thyromental distance
less than three finger breaths, limited neck range of motion
Describe the 4 modified Mallampati classes.
With the mouth fully open and the tongue protruded:
● Class 1: Tonsillar pillars, tonsils, and uvula visible
● Class 2: Uvula partially obscured by tongue base, upper
tonsils visible
● Class 3: Soft palate and base of uvula visible
● Class 4: Only hard palate visible
What is the average duration of effect for deep true vocal-fold injection using the following materials: Gelfoam, bovine collagen, micronized Alloderm (Cymetra), fat, Teflon,calcium hydroxylapatite (Radiesse)?
● Gelfoam: 4 to 6 weeks ● Bovine collagen: 3 to 4 months ● Micronized Alloderm: 3 to 4 months ● Fat: Several years ● Teflon: Indefinite ● Calcium hydroxylapatite: 2 years, some longer
The use of Teflon in true vocal-fold injection augmentation has been limited by what complication?
Teflon granuloma
Patients with what finding on videostroboscopy
are less likely to benefit from true vocal-fold
injection augmentation?
Posterior glottic gap. Laryngeal framework surgery has a
higher chance of success.
What test must be obtained before performing
true vocal-fold injection augmentation with bovine
collagen?
Allergy skin testing is required due to the risk of allergic
reaction to the material.
What are the two different types of vocal fold injection augmentation?
● Superficial (intracordal)
● Deep injection augmentation
What are the preferred needle-placement loca-
tions for deep true vocal-fold injection augmen-
tation?
The ideal location is at the intersection where a line drawn
laterally from the vocal process tip intersects the superior
arcuate line (transition from the superior surface of the
vocal fold to the ventricle). A second injection, if needed, is
often done along the superior arcuate line at the level of the
mid-membranous vocal fold.
Define the superior arcuate line of the true vocal fold.
The superior arcuate line is the transition point from the
superior surface of the true vocal fold to the ventricle.
What is the desired depth of injection for deep true vocal-fold injection augmentation?
3 to 5 mm into the thyroarytenoid muscle
What are the three approaches used for trans-cervical true vocal fold injection augmentation?
● Thyrohyoid
● Cricothyroid
● Translaryngeal
Define the desired effect on the true vocal folds in
each of the four types of thyroplasty.
● Type I: Medial displacement
● Type II: Lateral displacement
● Type III: Shortening/relaxing
● Type IV: Lengthening/tightening
To avoid airway compromise after medialization
laryngoplasty, what should be true regarding the
contralateral true vocal fold?
It should be able to abduct completely during inspiration.
What materials are commonly used for implantation in medialization laryngoplasty?
Silastic, hydroxyapatite, and Gore-Tex strips
To avoid fracture of the thyroid cartilage after type I thyroplasty, what is the minimum width of
cartilage strut that must be left below the thyroplasty window?
3mm
To externally determine the horizontal plane of the true vocal fold within the thyroid cartilage, what
anatomical landmark must be completely exposed along the inferior border of the thyroid cartilage?
The inferior muscular tubercle of the thyroid cartilage must be completely exposed to define the plane of the inferior border of the thyroid cartilage, which parallels the long axis of the true vocal fold.
Why is the window for placing a Silastic implant during type I thyroplasty placed more posteriorly
in men than in women?
The thyroid cartilage in men tends to have a more acute
anterior angle. The window is therefore placed more
posteriorly to avoid overmedialization of the anterior true
vocal fold.
What are the indications for performing arytenoid
adduction in addition to type I thyroplasty?
Large posterior glottic gap or vocal-fold level mismatch
What landmarks can be used to help identify the muscular process of the arytenoid during arytenoid adduction?
After a window has been created in the posterior thyroid
lamina and the pyriform sinus mucosa has been retracted,
the muscular process of the arytenoid must be identified.
This can be done by palpation, by following the fibers of the posterior cricoarytenoid muscle superiorly to their attachment to the muscular process, or by looking approximately 1 cm superior to the cricoarytenoid joint.
During microflap excision of submucosal pathol-
ogy of the true vocal fold, where should the incision be located?
Directly over or just lateral to the pathology
