Videoendoscopic surgery for inaccessible glottic lesions

Objectives: lesions in the anterior segment of the vocal fold are sometimes difficult to access by means of conventional suspension microlaryngoscopy under general anesthesia because of anatomical factors such as short, stout and inflexible necks, reduced jaw protrusion, and long incisors. Various techniques have recently been proposed for the management of inaccessible glottic lesions, most of which are performed under general anesthesia. The use of flexible videoendoscopic surgery under topical anesthesia in two cases of anterior glottic lesions that could not be treated by means of conventional suspension laryngoscopy is described. Study design: case report. Methods: a flexible videobronchoscope with an instrument channel was inserted transnasally on an outpatient basis. While the examiner carried out the endoscopy, an assistant manoeuvred the biopsy forceps through the instrument channel, and removed the lesion. Results: both patients underwent the successful removal of an anterior glottic polyp, and the one-year follow-up evaluation revealed normal anatomy of the vocal folds and normal vocal function. Conclusions: flexible videoendoscopic surgery under topical anesthesia is a safe, simple and minimally invasive procedure that can be considered an alternative to traditional endoscopic surgery for inaccessible anterior glottic lesions.