Diathermy epiglottectomy: endoscopic technique

Abstract

Endoscopic epiglottectomy is usually performed using a surgical laser. Epiglottectomy may be indicated for the treatment of benign or malignant lesions and for the relief of airway obstruction caused by a floppy epiglottis. We present four patients who had endoscopic partial epiglottectomy using monopolar diathermy to treat a floppy epiglottis. All the four patients were male in their sixth and seventh decades with snoring and/or obstructive sleep apnoea syndrome (OSAS) due partly or wholly to a floppy epiglottis. Diathermy epiglottectomy is easily carried out using the laryngoscope, laryngeal instruments and curved rotating microdissection monopolar scissors (used in laparoscopic surgery). This was found to be safe and effective with minimal morbidity. It requires no elaborate preparation and could be performed in hospitals that have no laser facilities. It may be performed in conjunction with other procedures e.g. uvulopalatopharyngoplasty (UPPP) if necessary.

Epiglottis collapse in adult obstructive sleep apnea: A systematic review

“…Kenmore et al reported the case of a patient with inspiratory dyspnea due to a floppy epiglottis where they performed a V‐shaped epiglottidectomy of the upper‐central part with a laser, leaving the inferior aspect intact to prevent aspiration . Two studies reported their experience with performing epiglottectomy by using diathermy . Oluwasanmi et al described their outcomes for one OSA patient and three snorers who presented with a floppy epiglottis .…”

“…Epiglottectomy has also been performed using carbon dioxide (CO2) laser . In a study published by Golz et al, 27 patients were found to have an abnormal epiglottis that was obstructing into the hypopharyngeal space; the patients were treated with partial epiglottectomy using CO2 laser .…”

“…29,30 Oluwasanmi et al described their outcomes for one OSA patient and three snorers who presented with a floppy epiglottis. 30 Using diathermy, they resected the epiglottis just above the floor of the vallecula, which lead to complete resolution of the snoring. In the case of the OSA patient, epiglottectomy was performed in conjunction with UPPP, which led to a 50% improvement in the patient's AHI score (Table II).…”

Transoral Robotic Surgery: Supraglottic Laryngectomy in a Canine Model

“…Clinical data concerning the use of monopolar electrocautery in the supraglottis is sparse. Oluwasmni and Mal 14 performed monopolar diathermy partial epiglottectomy in four patients because of snoring or sleep apnea and found no significant problems with bleeding or airway edema, and three patients were discharged on the first postoperative day and one on the second postoperative day. Although these authors did suggest performing total epiglottectomy using monopolar diathermy was safe, from the perspective of bleeding and airway swelling, to date this has not been reported.…”

Maintenance of Hemostasis in Transoral Robotic Surgery

“…The use of robotic control of cautery imparts no difference in the effect of the cautery on the tis- sues. Further, the use of electrocautery in pharyngeal and laryngeal surgery has been demonstrated to be safe and to produce tissue injury similar to that of the carbon dioxide laser [11][12][13] . The real difference between conventional open pharyngeal or laryngeal surgery and robotic surgery is the management of large-caliber vessels.…”