Mayo Clinic otolaryngologist Dale C. Ekbom, M.D. demonstrates a microdirect laryngoscopy with vocal cord polyp removal.
Hello, this is Dale. Today we're gonna talk about micro flap excision of a vo full polyp. There's lots of different polyps. Um you know, all different shapes and sizes and, and uh one of the keys is to just remove what's abnormal. You're trying to save all the superficial lamb appropriate. You can, you're trying not to even see the ligament because you want to leave that area of superficial Lamar appropriate over the top. And this is more epithelial work as well as removing more of just the polaroid tissue. So here's the, here's the poll up in the left fold, closer up shot, you know, seeing normal tissue and then going right into abnormal and that's where we began our incision. Uh This is are 70 degree pictures as well and looking on the other contralateral side too to make sure there's no reactive change. So I usually I start with my suction uh or a probe and just get a feel for where is this polyp attached to? Often it's on the inferior or inf uh inferior lip of the two vocal folds. This is a sickle knife that we start with and uh and you try to have a sharp, very sharp sickle. If it's not so sharp, you can start it with a sickle and then uh finish with an up scissors if you need to. Uh But here we are extending it. It's bleeding a little bit, which is typical with the blood vessels that feed into these polyps. So I have an epinephrine. So pledge it here 1 to 10,000 epinephrine and that stops any sort of oozing in that area. It also can be used a little as a kitner just to push around and just dissect a little bit of the pal contents off of the superficial propria. So there you're seeing within the uh micro flap right now. Next, I have my Ossoff micro fla elevator and I push more laterally, but I'm just uh wanting to just remove pal content contents. So I take this up and down into your posterior to carefully uh excise out any of the polyp that's there, leaving a nice, smooth uh edge deep. I use the uh um the graspers just to pull just to grasp just the edge of the epithelium. There you see how careful you are and pulling that out. Um So you can see the inside of the, of the uh micro flab and then you dissect some of the inside portion up away from the uh inferior portion of the micro fla of the micro flap. And then I make an incision as I've dissected up the poo contents so that my inferior flap will lay up against my super flab. So that's dissecting out the contents. You can go through with your micro flap elevator or you can use a scissor. Uh This time I went through with the elevator and that works fine. And then I take my up scissors and just finish the cut trying to avoid a dog ear. So you're right at the corner and you connect it and that will uh prevent you from, prevent you from having to re excise. This anti portion is always difficult. You have to uh really uh um again, go at an angle here and uh that typically prevents excess tissue. And if there is any residual, you can use a laser to remove that. Um If you can't get it with the scissors and I lay, then I push up the lower flap. So it connects to the uh superior one and it looks great with a zero degree scope. And we also look at it with the 70 degree scope. If there's a little gap, that's, it's not, it's not bad. It um uh because you know, you've gotten that lower flap very close and it typically heals really well. There's excellent reepithelialization typically, but you do want to get that those flaps as close as you can together. So that's how we do uh uh a micro flap procedure. Thanks for listening.