The Application Of Modified Cricothyroid Approach Assisted Byendoscopy In Laryngeal Surgery For Patients With Difficultexposure Of Supporting Laryngoscope

Objective:Abstract Objective: To explore the value of endoscopic-assisted modified cricothyroid approach laryngeal surgery in patients with difficult airways,and to evaluate its safety.Methods: Patients who were hospitalized in the Department of Otorhinolaryngology and Head and Neck Surgery of the People’s Hospital of Shucheng County,Anhui Province from May 2017 to October 2019 and underwent laryngeal surgery were selected as the research subjects,including vocal cord polyps,Renk’s edema,and laryngeal papilloma And early laryngeal cancer(T1,T2),etc.,a total of 376 cases.Evaluation of all patients before surgery,including measurement of upper and lower incisor distance(CM),neck circumference(CM),head and neck flexion and extension,body mass index(BMI),distance between chin to thyroid cartilage(CM)and Mallampati classification,Yamamoto Grading and upper lip bite test,as well as other routine preoperative inspections,the distance between the upper and lower incisors is less than 4cm,the neck circumference is greater than 40 cm,the back angle of the neck is less than 30 degrees,the body mass index BMI is greater than 25,and the distance from the chin to the thyroid cartilage is less than 6 cm,Mallampati grade III or above,Yamamoto grade III or above,upper lip bite test grade III as a risk factor for difficult exposure of supporting laryngoscopes and systematic analysis of them,focusing on patients with risk factors for difficult exposure of supporting laryngoscopes Prepare and communicate.When the conventional support laryngoscope cannot complete the operation and the wide-base disease is not suitable for resection under the fiber electronic laryngoscope,immediately switch to the modified cricothyroid approach with the assistance of endoscopy.All 376 patients underwent general anesthesia,and under the condition of sufficient muscle relaxation,the support laryngoscope was inserted for surgery.A total of 19 patients had difficulty in exposure of the glottis under the support laryngoscope,including 7 patients with vocal cord polyps,and 5 patients with angle mirror compression The larynx was barely exposed.Polyps were excised with self-processed and curved pliers.2 cases of smaller polyps were resected under electronic laryngoscopy.The remaining 12 cases were performed by modified cricothyroid approach,including 3 cases of Ren K’s edema.There were 2 cases of laryngeal papilloma,3 cases of vocal cord leukoplakia,2 cases of laryngeal squamous cell carcinoma,1 case of giant vocal cord polyp,and 1 case of vocal cord cyst.The surgical method is to support the laryngoscope after the failure to expose,pad the shoulders of the patient,make the head slightly tilted back(patients with cervical spondylosis do not force the position),after positioning the cricothyroid membrane,cut the skin and subcutaneous tissue across the upper and lower median of the flat cricothyroid membrane,and make an incision.Approximately 2cm;Expose the white line of the neck,cut in the middle of the white line to expose the deep neck fascia on the cricothyroid;Treat the blood vessels of the cricothyroid: 0.5-1cm on both sides of the midline at the level of the cricothyroid,suture the cricothyroid At the same time,a needle is sutured in the middle of the lower part of the upper edge of the cricoid cartilage,and the cricothyroid blood vessel and the thyroid blood vessel are sutured to form a communicating branch;the cricothyroid membrane is cut and the operation is completed: an electric knife is used to incise the deep cervical tendons on the surface of the cricothyroid membrane Separate or cut part of the deep neck fascia along the surface of the cricothyroid membrane to expose the cricothyroid membrane.Finally,use a blade to cut the cricothyroid membrane up and down in a horizontal line for about 1cm(appropriately lengthen as needed),with two teeth The small middle ear mastoid spreader appropriately propagates the incision,and chooses 45° or 70° nasal endoscope to extend from bottom to top according to the exposure situation,and complete the operation with plasma or laryngeal microscopy under the monitoring of the imaging system;incision suture : After the operation,the skin and subcutaneous tissue can be sutured with two needles.The incision is pressure-wrapped with auxiliary materials.Generally,it will heal itself after a week.Young patients can suture the skin incision after confirming that the cough is not leaking.Results: All 12 patients successfully completed the operation.The visual field was exposed to satisfaction during the operation.No bleeding,suffocation,and glottal and subglottic stenosis occurred after the operation,and the sound recovery was satisfactory.Conclusion: The exposure of the supporting laryngoscope is significantly correlated with the distance between the upper and lower incisors,neck circumference,head and neck flexion and extension,body mass index(BMI),distance from the chin to thyroid cartilage,and Mallampati classification,etc.,which can be used to predict the occurrence of supporting laryngoscope surgery The probability of difficulty is that the cricothyroid approach is not a routine choice for laryngeal surgery.However,for patients with difficult airway exposure who are difficult to expose through the conventional approach,compared with surgical methods such as flexible endoscopes,arcs The treatment of glottis and subglottic lesions is significantly better than other surgical methods.It is a good choice for patients who cannot be exposed by conventional surgical approaches and is worthy of clinical promotion.