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- Negative Pressure Face Shield (NPFS) for Transnasal Laryngoscopy to Mitigate Dispersion of Bioaerosol in COVID Era
- KTP Laser Treatment through Flexible Transnasal Laryngoscopy in the COVID Era Setup in Main Operating Room for RRP
- KTP Laser for the Larynx
- KTP (potassium-titanyl-phosphate) laser in office treatment of vocal fold polyps
Clinical Images
Modified Operative Note
Preop Dx: Left vocal cord polyp, dysphonia
Postop Dx: Same
Procedure:
- Transnasal KTP laser and resection of left vocal fold polyp 64 J (30 Watts, 15 msec pulses, 2 pps) with use of Negative Pressure Face Shield (NPFS)
- Bilateral superior laryngeal nerve blocks (1cc to each side of 2% lidocaine with 1:100,000 epinephrine) (see: Superior Laryngeal Nerve Blocks Instruction Video)
Anesthesia:
- Glycopyrrolate 1 mg by mouth 1 1/2 hours preop;
- Bilateral superior laryngeal nerve blocks as above;
- Left nostril spray x 3 with 4% lidocaine 1% phenylephrine;
- Topical 4% lidocaine to larynx through 25 gauge sclerotherapy needle to vc's and subglottis (1.5 cc)
Findings:
- In addition to photos above (including setup)
- Use of the Olympus Slim Bronchoscope (BF-P190 - 003) through the left nostril via the NPFS (Neptune suction at 520 mm Hg) permitted delivery of 4% topic lidocaine through the 25 gauge sclerotherapy needle
- KTPV,1 to surrounding blood vessels
- KTP3,4 directly to hemorrhagic polyp
- Following resection with use of disposable EndoJaw Olympus forceps outer diameter 1.9 mm (minimal channel size of 2.0 mm)
- KTP V,1 to underlying blood vessels
- Total 64 J (30 W, 15 msec pulses, 2 pulses per second)
Laser Fiber
References
Tibbetts KM, Simpson CB. Office-Based 532-Nanometer Pulsed Potassium-Titanyl-Phosphate Laser Procedures in Laryngology. Otolaryngol Clin North Am. 2019 Jun;52(3):537-557. doi: 10.1016/j.otc.2019.02.011. Epub 2019 Mar 26. PMID: 30922560.
Madden L.L., Ward J., Ward A., et al: A cardiovascular prescreening protocol for unmonitored in-office laryngology procedures. Laryngoscope 2017; 127: pp. 1845-1849
