Novel Method Overcomes Nasal Discomfort in Office-Based Laser Surgery

What can be done to help patients with narrow nasal passages and/or nasal discomfort during office-based laser laryngeal surgery?

Background: Although channeled flexible laryngoscopes have permitted a transnasal approach for biopsies, vocal fold augmentation and unsedated laser laryngeal surgery, some patients with nasal anatomic restrictions experience significant nasal discomfort and cannot tolerate these procedures.

Study design: Description of technique used.

Setting: University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine School of Medicine, Orange.

Synopsis: The authors described their technique, which calls for the patient to hold and stabilize the tongue as the surgeon places a rigid angled telescope transorally for laryngeal visualization in the nondominant hand and an Abraham cannula transorally in the dominant hand. The flexible laser fiber is placed through the Abraham cannula to guide it. Energy from the pulsed dye laser, the potassium titanyl phosphate laser and CO2 flexible laser fibers is then delivered for management of glottic papillomatosis and leukoplakia. Treatment of glottic lesions is achieved successfully in all cases with titration endpoints identical to the transnasal approach.

Bottom line: When patients cannot tolerate transnasal passage of a flexible channeled laryngoscope, an alternative to surgery under general anesthesia is the transoral technique, which does not rely on distal chip endoscopes and can be performed with existing equipment in an office setting.

Citation: Verma SP, Dailey SH. Overcoming nasal discomfort – A novel method for office-based laser surgery. Laryngoscope. 2011;121(11):2396-2398.

—Reviewed by Sue Pondrom