DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Stridor secondary to redundant supraglottic tissue.
2. Laryngomalacia.
3. Left true vocal cord paralysis.
POSTOPERATIVE DIAGNOSES:
1. Stridor secondary to redundant supraglottic tissue.
2. Laryngomalacia.
3. Left true vocal cord paralysis.
OPERATION PERFORMED:
1. Microlaryngoscopy.
2. CO2 laser supraglottoplasty.
SURGEON: John Doe, MD
ANESTHESIA: General.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: Less than 20 mL.
OPERATIVE FINDINGS: Redundant edematous tissue of bilateral AE folds and epiglottis as well as false vocal cords bilaterally, left greater than right, difficult exposure of larynx due to supraglottic airway collapse.
INDICATIONS FOR OPERATION: This is a (XX)-year-old woman with a history of cardiac transplant and left true vocal cord paralysis, who was found on flexible laryngoscopy to have significant redundant tissue of the supraglottis as well as left arytenoid and AE fold prolapse on inspiration. The patient also has upper airway obstruction from obstructive sleep apnea and obesity and presents to the OR for removal of redundant and prolapsing supraglottic tissue.
DESCRIPTION OF OPERATION: After informed consent was reviewed with the patient, the patient was brought to the operating room and placed on the table in the supine position. Once a suitable plane of anesthesia was obtained, the patient was endotracheally intubated by anesthesia personnel with laser-safe endotracheal tube. Next, the table was turned to 90 degrees after tooth guard was placed. Dedo laryngoscope was inserted to expose the supraglottic tissue by retracting the endotracheal tube inferiorly. The Dedo was placed underneath the epiglottis, although the true vocal cords were seen and were edematous. Adequate exposure for suspension laser or supraglottoplasty was not achieved with the Dedo laryngoscope; this was removed.
Jako laryngoscope was then inserted and was unable to adequately visualize the airway with the endotracheal tube in place. The endotracheal tube was removed, and the Dedo laryngoscope was inserted in adequate position to visualize the supraglottis tissues. The patient was endotracheally intubated periodically throughout the case through the Dedo laryngoscope. Laryngoscope was placed in suspension. Operating microscope was then used to visualize the supraglottic tissue. With the endotracheal tube removed, the left AE fold and redundant false vocal cord tissue was grasped, retracted medially, and dissected away from the underlying structure with CO2 laser on 2 watts continuous SuperPulse. After left AE fold and false vocal cord redundant tissues were removed, attention was then turned to a redundant laryngeal surface of the epiglottis. Significant portion of this tissue was removed with CO2 laser in a similar fashion.
Next, the right arytenoid and AE fold tissue was similarly excised with CO2 laser taking care not to expose any underlying cartilage or injure the true vocal cord. True vocal cord was edematous at the conclusion of the case. The subglottis was visualized and was normal. True vocal cords themselves were normal with no lesions. The patient was removed from suspension. The Dedo laryngoscope was replaced, and the supraglottic tissue was adequately removed, and exposure of the glottis was much easier than prior to excision. Due to significant edema from length of surgery and multiple intubations, the patient was left intubated at the conclusion of the case and was stable upon transport to the PACU.
