How To: Novel Use of Ultrasonic Aspirator Device for Cricoid

INTRODUCTION

In laryngeal surgery, resection of large neoplasms has traditionally required an open, transcervical approach. This approach requires a neck incision and laryngofissure in order to access the endolarynx. Advances in endoscopic techniques have minimized the need for an open neck surgery. Compared to traditional open surgery, endoscopic procedures are associated with less patient morbidity and shorter postoperative recovery.

Cricoid chondromas are benign growths that can result in dysphagia, dysphonia, and airway obstruction. These masses tend to be slow-growing, and patients can experience symptoms for several years before a diagnosis is made (Curr Opin Otolaryngol Head Neck Surg. 2004;12:98–105; Ear Nose Throat J. 1996;75:540–544). Grossly, these masses are firm, smooth, calcified submucosal lesions. Surgery is the mainstay treatment for cricoid chondromas, and typically conservative, subtotal resection is recommended. Malignant transformation into chondrosarcoma is possible, which has metastatic potential depending on the grade of dedifferentiation.

The ultrasonic aspirator (UA) system is used as a surgical tool to resect rigid or calcified structures. This tool selectively debrides solid structures while simultaneously sparing surrounding, softer tissues. UA has not been frequently used in laryngeal surgery. Yawn et al. (Laryngoscope. 2016;126:941–944) reported using the UA system during endoscopic split of the posterior cricoid cartilage for patients with posterior glottic stenosis and an ossified cricoid cartilage. Daniero et al. (Otolaryngol Head Neck Surg. 2011;145:P200–P200) reported their findings with UA during four medialization thyroplasty window creations and two laryngofissure approaches. The authors found that the device is safe and requires a limited learning curve.

To our knowledge, UA has not been described as a tool for endoscopic removal of laryngeal chondroma. We present two cases of endoscopic removal of cricoid chondroma using the UA. This technique may have value since it allows the surgeon to debride large endolaryngeal masses while sparing delicate laryngeal structures and avoiding a transcervical surgical approach.

METHOD

Two patients who underwent transoral resection of cricoid chondroma using the UA system were retrospectively reviewed between 2018 and 2019. Indications for surgery, patient factors, and operative technique were collected. Pre- and post-procedure voice and swallowing indices were compared, including Voice Handicap Index-10 (VHI-10) and Eating Assessment Tool- 10 (EAT-10) scores.

TECHNIQUE

Figure 1.

(A) Transoral view of subglottic cricoid chondroma. (B) The mass was based off of the anterior face of the posterior cricoid abutting the medial portion of the right arytenoid cartilage. (C) After resection of the mass, there was significant improvement in the caliber of the airway.