LXXVIII An Approach to the Internal Laryngocele and other Submucosal Lesions of the Larynx

Abstract

by invitation) FORT CARSON, COLO.Our purpose here is to present a surgical approach which we have found successful in dealing with the problem of the internallaryngocele. The pathophysiology and natural history have been recently reviewed by Krekorian," Cody," as well as by ourselves.i' and will not be repeated here. Instead, we would like to direct our attention to a description of the surgical treatment of this lesion.The diagnosis of these lesions has been discussed previously,t-s,lo and will not be discussed in detail. Usually the lesion can be diagnosed by direct laryngoscopy, and the differential diagnostic problems solved by soft tissue films of the neck. In contrast to the findings of others, we have found properly exposed anterior and lateral soft tissue films of the neck more useful than tomograms in diagnosing these lesions. Moreover, the use of Valsalva maneuvers is considered dangerous by somes due to the occasional problem of acute inflation and obstruction.Although Lore" and others have felt that these lesions are adequately controlled by endoscopic excision, we believe that an external approach offers better results. The procedure which we have used is not new. It is an adaptation of procedures described

The External Approach for Submucosal Lesions of the Larynx

“…Tracheotomy is also not required for these submucosal lesions and should only be used if there is a high chance of violating the laryngeal lumen. In support of this, Netterville et al 17 described a series of 11 patients in which lateral laryngotomies were performed to remove granulomas. Initially, the procedure was carried out on patients with extensive Teflon granulomas (first 4 patients), who were placed under general anesthesia with preliminary tracheotomies performed to ensure a secure airway in the event of postoperative swelling.…”

“…Teflon granulomas 17 : these lesions occur as a complication of Teflon injections used in the management of vocal fold paralysis.…”

Bilateral Saccular Cysts after Cocaine Use

“…In 1953 Johnston 12 was one of the earliest authors to advocate lateral thyrotomy for removal of external or internal saccular cysts or laryngoceles. In 1966 Yarington and Frazer 13 modified previous external techniques for internal and external laryngoceles or saccular cysts. The key maneuvers have been the preservation of the superior laryngeal nerve and the use of the inverting purse‐string suture at the neck of the sac.…”

Laryngopyocele (A report of two cases)

“…A preliminary tracheostomy was performed under local anaesthesia. Following adequate general anaesthesia the procedure described by Yarington and Frazer (1966) inferiorly and a subperichondrial resection of the superior portion (about 1/3) of the ipsilateral thyroid ala was performed. At this stage, it was decided to decompress the sac to facilitate dissection.…”