For Laryngomalacia, Microdebrider-Assisted Supraglottoplasty Preferred

Removal of the lesion may be diagnostic as well as palliative; therefore, before doing the procedure, determine whether the tissue needs to be preserved for pathological study.

The microdebrider has also been used for partial tonsillectomy. With traditional tonsillectomy, the capsule enclosing the tonsil is removed, exposing the throat muscles, large blood vessels, and nerves. In one series (Otolaryngol Head Neck Surg January 2005) physicians were able to remove 90% to 95% of the tonsils, leaving the capsule in place to protect the throat muscles, blood vessels, and nerves. In this series, patients treated with the microdebrider had less pain and swelling, as well as shorter recovery times, than those undergoing traditional tonsillectomy. Furthermore, microdebrider-treated patients were three times more likely not to require pain medication three days after surgery and almost twice as likely to resume normal activity at that time than patients treated with traditional tonsillectomy.

In addition to supraglottoplasty, other potential applications of the microdebrider include sinus surgery and microdebrider Eustachian tuboplasty. Preliminary results in these conditions are encouraging.

Caveat

Researchers caution that the tool can remove a great deal of tissue very quickly, so the operator must be aware at all times of the location of the blade and be alert to risks. Although the microdebrider is a promising tool, it should be used with appropriate respect and vigilance for potential complications.

Laryngoscope Highlights

Using a Portable Electromyography Device in Treating Spasmodic Dysphonia

Adductor spasmodic dysphonia (SD) is due to involuntary overcontraction of the thyroarytenoid muscles during speech. Currently, Clostridium botulinum bacterial toxin (Botox) is an effective treatment option when injected into the thyroarytenoid muscle, as it blocks the release of acetylcholine at the neuromuscular junctions, causing denervation of the thyroarytenoid muscle. Electromyography (EMG) monitoring is an essential component in the identification of the thyroarytenoid muscles during Botox injection when the percutaneous approach is used. Benjamin T. Jeffcoat, MD, and John M. Schweinfurth, in a How I Do It article, discuss using a handheld, audible-only EMG device as an efficient, safe method for identification of the thyroarytenoid muscle for Botox injection.

The investigators reviewed the charts of 38 patients who received intramuscular Botox injections in treatment of adductor SD over a three-year period; 13 met the inclusion criteria. Using the handheld, audible-only EMG monitor, Dr. Jeffcoat performed all injections. A missed injection was defined as no improvement in voice quality within two weeks following the injection; a successful injection was defined as subjective or objective improvement in voice quality within two weeks following the injection, for a duration of at least one month.