title: Overcoming nasal discomfort--a novel method for office-based laser surgery.
abstract: OBJECTIVE
  The passage of a flexible channeled laryngoscope for office-based laser laryngeal surgery can be limited by narrow nasal passages, nasal discomfort, or both. We describe a novel method for delivering the laser fiber transorally with simultaneous laryngeal visualization to avoid these limitations. This technique can be employed with instruments available in most otolaryngologists' offices.
  
  
  METHODS
  A retrospective chart review was performed and procedural details were recorded.
  
  
  RESULTS
  Technical description: A laser fiber was threaded through the shaft of an Abraham cannula. A patient was seated in an otolaryngology examination chair and instructed to hold and stabilize his own tongue. Using his nondominant hand, the surgeon placed a rigid angled telescope into the patient's oral cavity for laryngeal visualization. Using his dominant hand, the surgeon simultaneously introduced the laser fiber threaded through the Abraham cannula into the patients oral cavity and guided it towards the patients larynx. Energy from the PDL, KTP, or CO(2)  flexible laser fibers was then delivered for management of glottic papillomatosis and leukoplakia. Treatment of glottic lesions was achieved successfully in all cases with titration endpoints identical to the transnasal approach.
  
  
  CONCLUSIONS
  For patients who cannot tolerate transnasal passage of a flexible channeled laryngoscope during office-based laser laryngeal surgery, an attractive alternative to surgery under general anesthesia is the transoral technique. This approach does not rely on distal chip endoscopes and can be performed with existing equipment in an office setting.
authors: University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine School of Medicine, Orange, California, USA.
authors: Sunil P
authors: SP
authors: Verma
authors: Seth H
authors: SH
authors: Dailey
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007642:Keratosis / Q000601:surgery*; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007828:Laryngoscopy / Q000295:instrumentation*; D053685:Laser Therapy / Q000295:instrumentation*; D054025:Lasers, Dye / Q000627:therapeutic use; D053844:Lasers, Solid-State / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010212:Papilloma / Q000601:surgery*; D011230:Precancerous Conditions / Q000601:surgery*; D012189:Retrospective Studies