PMC8639592_01
Endoscopic view of Type 2 laryngeal web.
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Type 2 Laryngeal web (Figure 1) who presented with a weak voice. The case was retrospectively reviewed under University of Iowa IRB No: 20210205.
Mucosal flap laterization for laryngeal web: (A) Schematic view of Type 2 laryngeal web. (B) Remnant mucosal flap after unilateral laser incision of the laryngeal web. (C) An 18-gauge needle with a pre threaded looped 3-0 prolene suture is passed under ultrasonographic guidance targeting superior to the true vocal fold near the anterior commissure and is pulled out endolaryngeally. (D) A 20-gauge needle with a 3-0 prolene suture is placed immediately inferior to the true vocal cord under ultrasound guidance and threaded into the loop. (E,F) The looped stitch is pulled out through the neck, which carries the single stitch out, placing the suture with the mucosal flap wrapped on the left vocal cord.
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The microscope is then brought into the field and after implementation of all laser safety precautions, a straight handheld CO2 laser set at 2W, 20mj ultrapulse repeat mode (Lumenis, Inc) is used to incise the laryngeal web close to the edge of the right vocal fold (Figures 2A,B). An 18-gauge needle with a pre threaded looped 3-0 prolene suture (polypropylene; Ethicon, Somerville, NJ) is placed into the neck incision site and advanced along the axial plane under ultrasonographic guidance targeting superior to the true vocal fold anteriorly near the anterior commissure (Figures 2C, 3). The needle is identified endoluminally, and the suture is pushed through the needle which is drawn superiorly with a grasper until taken out through the laryngoscope (Figure 2D). Next, a 20-gauge needle with a 3-0 prolene suture end threaded inside the bevel of the needle is placed immediately inferior to the true vocal cord under ultrasound guidance (Figure 2E). The looped stitch is pulled out through the neck, which carries the single stitch out placing the suture with the mucosal flap wrapped on to the left vocal cord (Figures 2F, 4).
Axial ultrasound of the larynx with in-axis placement of the 18 G needle.
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An 18-gauge needle with a pre threaded looped 3-0 prolene suture (polypropylene; Ethicon, Somerville, NJ) is placed into the neck incision site and advanced along the axial plane under ultrasonographic guidance targeting superior to the true vocal fold anteriorly near the anterior commissure (Figures 2C, 3).
Endoscopic view of the mucosal flap laterization. Suture is visible on the left vocal cord.
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The looped stitch is pulled out through the neck, which carries the single stitch out placing the suture with the mucosal flap wrapped on to the left vocal cord (Figures 2F, 4).