title: Intraoperative inflation of laryngocele with LMA.
abstract: OBJECTIVE
  Laryngoceles are pathologic air filled dilations of the laryngeal ventricle. They are most often benign and incidental findings. Resection may be necessary in the setting of infection, airway obstruction, dysphagia, and phonatory disturbances. External laryngoceles are almost universally treated with open resection via a lateral or midline cervical approach. Care must be taken to resect the laryngocele in its entirety to avoid recurrence. In cases of recurrent infection, normal surgical planes are often fibrosed and obscured increasing the risk of neurovascular sacrifice and functional losses.
  
  
  METHODS
  We are reporting a case of recurrent infections in a large, palpable external laryngocele. During resection the patient was ventilated using an endotracheal tube (ETT). Additionally, a laryngeal mask airway (LMA) was inserted posterior to the ETT, resting in the hypopharynx and attached to a Jackson Rees circuit. Air was passed through the LMA to inflate the laryngocele and better define its borders. The LMA was also used to identify the root of the laryngocele in the paraglottic space and ensure its airtight closure.
  
  
  RESULTS
  The LMA assisted our dissection and helped progress the surgery safely in a fibrosed surgical field. We have not seen this method described previously. The patient continues to be free of recurrence 2 years after surgery.
  
  
  CONCLUSIONS
  While in most cases, with careful surgical technique, even a fibrotic and scarred laryngocele can be excised in its entirety without neurovascular sacrifice. In some cases where this may be difficult with a traditional approach, we offer the intra-operative trumpet maneuver as a viable method of better delineating the borders of a laryngocele.
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery at Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA. Electronic address: nathangonik@gmail.com.
authors.forename: Nathan
authors.initials: N
authors.lastname: Gonik
authors.forename: Sudarshan
authors.initials: S
authors.lastname: Setty
authors.forename: Ellise
authors.initials: E
authors.lastname: Delphin
authors.forename: Tracey
authors.initials: T
authors.lastname: Straker
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Schiff
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000295:instrumentation* / Q000379:methods; D007442:Intubation, Intratracheal; D017214:Laryngeal Masks; D059608:Laryngocele / Q000601:surgery*