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An underreported complication of laryngeal microdebrider: vocal fold web and granuloma: a case report
1Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA. mm6nj@virginia.edu
Objectives/Hypothesis:
The microdebrider has become a valuable instrument for otolaryngologists. It is now used in the larynx for treatment of recurrent respiratory papillomatosis, laryngeal stenosis, and debridement of large cancers for airway control. There are few reported complications reported with the use of the microdebrider in the larynx.
Study Design:
A case report.
Methods:
A patient with a vocal fold polyp underwent removal of the polyp with a microdebrider at an outside institution. He presented to our clinic 2 months after the excision with a severely strained near aphonic voice. On rigid stroboscopic examination we saw a large anterior commisure laryngeal web with a granuloma. This was repaired by granuloma excision, web lysis, buccal graft, and laryngeal stent placement.
Conclusions:
The microdebrider is an extremely valuable tool for the otolaryngologist. Violation of the epithelium and the lamina propria with muscle exposure can result in serious damage to the vocal folds. When using powered instrumentation the surgeon should use the upmost caution in the larynx to avoid causing debilitating injury and scar with subsequent dysphonia.
Insights
Microdebrider use in the larynx can cause serious vocal fold injury, leading to dysphonia. Surgeons must exercise extreme caution when using this tool to avoid debilitating damage and scarring.
Area of Science:
- Otolaryngology
- Laryngeal surgery
Background:
- The microdebrider is increasingly utilized in laryngeal procedures, including treating recurrent respiratory papillomatosis, laryngeal stenosis, and managing large cancers for airway control.
- Few complications have been reported with microdebrider use in the larynx.
Observation:
- A patient developed severe dysphonia and a laryngeal web with a granuloma two months post-vocal fold polyp removal using a microdebrider.
- Examination revealed a large anterior commisure laryngeal web and a granuloma.
Findings:
- Microdebrider use, particularly violating the epithelium and lamina propria, can lead to significant vocal fold damage.
- This damage can result in debilitating injury, scarring, and subsequent persistent dysphonia.
Implications:
- Surgeons must exercise utmost caution when employing powered instrumentation like microdebriders within the delicate laryngeal structures.
- Careful technique is crucial to prevent iatrogenic injury and preserve vocal fold function.
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