University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine School of Medicine, Orange, California, USA.
Laryngoscope. 2011 Nov;121(11):2396-8. doi: 10.1002/lary.21911. Epub 2011 Oct 12.
The passage of a flexible channeled laryngoscope for office-based laser laryngeal surgery can be limited by narrow nasal passages, nasal discomfort, or both. We describe a novel method for delivering the laser fiber transorally with simultaneous laryngeal visualization to avoid these limitations. This technique can be employed with instruments available in most otolaryngologists' offices.
A retrospective chart review was performed and procedural details were recorded.
Technical description: A laser fiber was threaded through the shaft of an Abraham cannula. A patient was seated in an otolaryngology examination chair and instructed to hold and stabilize his own tongue. Using his nondominant hand, the surgeon placed a rigid angled telescope into the patient's oral cavity for laryngeal visualization. Using his dominant hand, the surgeon simultaneously introduced the laser fiber threaded through the Abraham cannula into the patients oral cavity and guided it towards the patients larynx. Energy from the PDL, KTP, or CO(2) flexible laser fibers was then delivered for management of glottic papillomatosis and leukoplakia. Treatment of glottic lesions was achieved successfully in all cases with titration endpoints identical to the transnasal approach.
For patients who cannot tolerate transnasal passage of a flexible channeled laryngoscope during office-based laser laryngeal surgery, an attractive alternative to surgery under general anesthesia is the transoral technique. This approach does not rely on distal chip endoscopes and can be performed with existing equipment in an office setting.
在门诊激光喉部手术中，由于鼻腔狭窄、鼻腔不适或两者兼而有之，可能会限制柔性通道喉镜的通过。我们描述了一种将激光光纤经口传递并同时进行喉部可视化的新方法，以避免这些限制。该技术可与大多数耳鼻喉科医生办公室中可用的仪器一起使用。
对病历进行回顾性图表审查，并记录手术过程的详细信息。
技术描述：将激光光纤穿过 Abraham 套管的轴。患者坐在耳鼻喉科检查椅上，指示他握住并固定自己的舌头。手术医生用非优势手将刚性角度望远镜放入患者口腔以进行喉部可视化。手术医生用优势手同时将穿过 Abraham 套管的激光光纤引入患者口腔并引导其向患者的喉部。然后将 PDL、KTP 或 CO2 柔性激光光纤的能量输送用于治疗声门型乳头状瘤病和白斑病。在所有病例中，通过这种经口技术成功地治疗了声门病变，并且滴定终点与经鼻方法相同。
对于不能耐受在门诊进行激光喉部手术时经鼻通过柔性通道喉镜的患者，全身麻醉下手术的一个有吸引力的替代方法是经口技术。这种方法不依赖于远端芯片内窥镜，并且可以在办公室环境中使用现有设备进行操作。
