Cervical Transmembrane Thyrohyoid Video Access for Glottic Lesion Resection: Description of a New Surgical Technique and Case Report.

Abstract

Introduction: In cases where laryngoscopy is difficult, part or all of the vocal cords may not be visualized with conventional laryngoscopy, making laryngeal microsurgery challenging or even impossible. It is therefore necessary to develop combined approaches, such as the use of the laryngoscope in conjunction with a high-definition (HD) endoscopic video system.

Objective: Understanding alternative surgical techniques and studying the predictors of difficult laryngeal exposure risk have been become essential for the success of endoscopic laryngeal surgery in the treatment of laryngeal cancers. This case report presents an innovative technique that combines a Cervical Transmembrane Thyrohyoid Video Access (CTTVA) for resection of an anterior glottic lesion.

Case report: A 54-year-old male patient with an 8-month history of dysphonia underwent videolaryngoscopy, which revealed a leukoplakic lesion on the anterior third of the left vocal fold. Direct laryngoscopy failed to allow biopsy. A 1.5 cm incision was made at the upper edge of the thyroid cartilage. After subcutaneous dissection and identification of the thyrohyoid muscle, an opening was made in the thyrohyoid membrane, providing access to the lesion, which was resected using a 0° endoscope (4 mm diameter, 17 cm length). A type III cordectomy was performed, and histopathology confirmed moderate dysplasia with clear margins.

Discussion and conclusion: The patient had a high Cormack-Lehane score, limiting visualization of the anterior larynx. Early recognition of this risk allowed the surgical team to implement a novel combined approach via the thyrohyoid membrane using 0° optics. This provided excellent access to the supraglottic, glottic, and subglottic regions, enabling complete lesion resection without the need for laryngofissure or tracheostomy.