Gray Minithyrotomy
Video Type: CVideo- 2-5 min videos of a particular surgery or technique. These again show major events in the surgery
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Author: Amit Patel
Published:
Specialties: Laryngology, Otolaryngology
Schools: Weill Cornell Medical College





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Contributors: Michael Lerner and Lucian Sulica
Gray Minithyrotomy with fat implantation
Procedure
Gray Minithyrotomy
Indications
Vocal fold scar, Sulcus vocalis, Mild vocal fold bowing, especially when associated with age-related alterations in lamina propria thickness and pliability
Contraindications
Instrumentation
Setup
General anesthesia
Use as small an endotracheal tube as possible: 5.0 for females, 5.5 for males
IV steroids
Primary surgeon will be more comfortable working from the patient�¢ï¿½ï¿½s right if right handed and vice versa
Suspension laryngoscopy equipment
0, 30, 70-degree endoscopes
22-gauge needle
Powered drill with 3-mm cutting burr
Mastoid curette
Tympanoplasty tray with Duckbill and Gimmick elevators, blunt probes, Belluci scissors (straight and angled), Alligator forceps
Preoperative Workup
Laryngoscopy with stroboscopy to show scar/sulcus vocalis
Anatomy and Landmarks
- Suspension laryngoscopy is performed to expose the entire glottis and to be visualized with a 0-degree endoscope
- 2-3 cm incision is centered over the prow of the thyroid cartilage and dissection is carried out in the midline to the anterior face of the thyroid cartilage
- Fat is harvested from the area of the incision, 1-2 ml per vocal fold
- Under endoscopic visualization, a 22-gauge needle is used to identify the midline/anterior commissure
Advantages/Disadvantages
Complications/Risks
- Risks of laryngoscopy - injury to teeth, lips, tongue, gums, persistent tongue numbness/alteration in taste
- Vocal fold epithelium perforation (may be unavoidable in cases of severe scar)
- Pinhole perforations do not require that the procedure be terminated
- Small perforations may be patched using a piece of perichondrium from the outside of the thyroid cartilage
- In the presence of a large tear, the procedure is best left abandoned
- Suboptimal results
- Fat implantation does not restore normal voice in most cases as it is not a perfect replacement for the lamina propria
Disclosure of Conflicts
- Risks of laryngoscopy - injury to teeth, lips, tongue, gums, persistent tongue numbness/alteration in taste
- Vocal fold epithelium perforation (may be unavoidable in cases of severe scar)
- Pinhole perforations do not require that the procedure be terminated
- Small perforations may be patched using a piece of perichondrium from the outside of the thyroid cartilage
- In the presence of a large tear, the procedure is best left abandoned
- Suboptimal results
- Fat implantation does not restore normal voice in most cases as it is not a perfect replacement for the lamina propria
Acknowledgements
References
Chapter 48, The Gray Minithyrotomy for Vocal Fold Scar/Sulcus Vocalis Operative Techniques in Laryngology, Clark A. Rosen and C. Blake Simpson. 2008.
Our Partners
Grace Medical – Bryan Medical – American Pediatric Surgical Association – American Association of Surgical Physician Assistants – American Pediatric Surgical Nurses Association – International Association of Student Surgical Societies – International Journal of Medical Students – InciSion – Global Surgery Student Alliance – National Surgery Association – Women in Surgical Education – Australasian Students’ Surgical Association – Surgeon Masters – Physicians for Peace – The Physician’s Edge – MultiLearning Group
Institutions using CSurgeries
Associations
American Pediatric Surgical Association American Association of Surgical Physician Assistants American Pediatric Surgical Nurses Association International Association of Student Surgical Societies Global Surgery Student Alliance National Surgery Association Australasian Students’ Surgical Association MultiLearning Group
Home Page Video Credit
Airman 1st Class Kirsten Brandes | Date Taken: 03/30/2017
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