Office Laser Laryngology: A Paradigm Shift.

OBJECTIVES: To present the value of office-based laryngological procedures as an effective alternative method to the treatment of benign and malignant laryngeal pathologies. METHODS: We have reviewed the technological advancements of fiber-guided laser systems, fiberoptic endoscopes, and high-definition imaging systems that have enabled office-based laryngological procedures. We describe the importance of case and patient selection, the available laser systems, and the technique applied. RESULTS: Several benign and malignant pathologies can be now treated in the office under local anesthesia with angiolytic or thermocoagulative lasers and with success rate comparable to that of general anesthesia. Safety guidelines and laser precautions must be implemented invariably to protect the patient and caregivers from the untoward effects of laser. Although there is considerable reduction of cost with office procedures, there are risks of undertreatment, increased repeatability, as well as tissue edema from the burning effect. CONCLUSIONS: The low learning curve, high patient satisfaction rate, and excellent results indicate that in-office laser procedures have become an effective weapon in our armamentarium.

Anesthetic Management of the Narrowed Airway.

Airway narrowing can be idiopathic or can occur as a result of airway tumors, hematomas, infections, and other pathologic conditions. Endoscopic management variously involves balloon dilatation, stent placement, laser vaporization of pathologic tissue, microdebridement, and other interventions, using either a rigid or a flexible bronchoscope. Jet ventilation is frequently used in such settings, especially when the presence of an endotracheal tube would interfere with the procedure. In desperate cases, extracorporeal membrane oxygenation may be used in managing the critical airway.

Sphenoid sinus mucocele: late complication of Sphenoidotomy.

Sphenoid sinus mucocele is an infrequent but well-recognized entity in sinus pathology. The symptoms produced by it are related to the anatomical surroundings of the sphenoid sinus. We describe a case of sphenoid sinus mucocele presenting with ipsilateral oculomotor nerve palsy 10 years after endoscopic sphenoidotomy. The patient underwent emergency endoscopic decompression of the sphenoid sinus with marsupialization of the mucocele, resulting in immediate remission of his symptoms. We conclude that the otorhinolaryngologist should be aware of such a potential complication when counselling the patient prior to endoscopic sinus surgery.