Laryngocoele, laryngocele - Vula - University of Cape Town

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SLNSLASTAAdminister 24hrs’ perioperative antibioticsshould mucosa be breachedInsert a suction/pencil/corrugated drainand close the woundBecause mucosal defects would besupraglottic, postoperative surgical emphysemaand airway obstruction areunusualInternal cystNeckFigure 17: Identify the superior laryngealnerve (SLN) where it emergesdeep to the superior thyroid arteryExternal cystSLASLNSTAThyroidFigure 19: Free cyst from the superiorlaryngeal artery (SLA), superior laryngealnerve (SLN) and deliver it fromparaglottic spaceThyrohyoidOmohyoidFigure 18: Retract omohyoid andthyrohyoid muscles to expose top edgeof thyroid cartilageSLNSLASTAFree the cyst from the perichondriumon the medial aspect of the thyroidlamina, and deliver it from the paraglotticspace. Carefully peel the cystoff the internal branch of the superiorlaryngeal nerve and from the mucosaoverlying the medial aspect of the aryepiglotticfold, and deliver the cyst(Figures 19, 20)Inspect the wound for tears or breachesin the mucosa which, if present, arerepaired with absorbable suturesFigure 20: Final view of key structuresTo gain additional exposure to the internalcomponent of the cyst in the paraglotticspaceIncise the thyroid perichondrium alongthe superior and posterior margins ofthe thyroid lamina (Figure 21)6
Reflect the perichondrium from thelateral aspect of the thyroid laminawith a Freer dissectorRemember that the vocal cord issituated midway between the thyroidnotch and the lower edge to the thyroidcartilage; therefore make the horizontalcartilage cut above this pointCut through the cartilage with aknife/oscillating saw, taking care not toenter the larynx (Figure 21)Remove and discard the posterosuperiorquadrant of the thyroid lamina togain access to the internal componentof the laryngocoele (Figure 22)Following removal of the cyst, suturethe perichondrial flap back to itsoriginal positionFigure 21: Cuts (yellow line) in thyroidcartilage to remove posterosuperior quadrantof thyroid cartilage (green)References1. Pinho M da C, et al. External laryngocele:sonographic appearance - a casereport. Radiol Bras. 2007 Aug[cited 2013 Mar 09]; 40(4):279-82http://dx.doi.org/10.1590/S0100-398420070004000152. de Paula Felix JA, Felix F, de MelloLFP. Laryngocele: a cause of upperairway obstruction. Rev. Bras. Otorrinolaringol.2008 Feb [cited 2013Mar 09]; 74(1): 143-6.http://dx.doi.org/10.1590/S0034-72992008000100023Author & EditorJohan Fagan MBChB, FCORL, MMedProfessor and ChairmanDivision of Otolaryngology, University ofCape TownCape TownSouth Africajohannes.fagan@uct.ac.zaFigure 22: Note how removal of thyroidlamina improves access to internal componentof laryngocoeleTHE OPEN ACCESS ATLAS OFOTOLARYNGOLOGY, HEAD & NECKOPERATIVE SURGERYwww.entdev.uct.ac.zaThe Open Access Atlas of Otolaryngology, Head & NeckOperative Surgery by Johan Fagan (Editor)johannes.fagan@uct.ac.za is licensed under a CreativeCommons Attribution - Non-Commercial 3.0 Unported License7
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Laryngocoele, laryngocele - Vula - University of Cape Town

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