Operative Note |
DIAGNOSIS: Supraglottic mass, rule out pharyngeal cancer. |
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SUMMARY: The patient was
taken to the operating room, appropriate monitors were placed and general endotracheal anesthesia was induced by the anesthesia team. Examination of the head and neck under anesthesia was performed. There were no neck masses. There were no masses of the
base of the tongue, and there were no masses of the preepiglottic space. However, the epiglottic lesion was palpable and firm. He was turned and a shoulder roll was placed to put the patient’s neck in extension. The Dedo laryngoscope was then introduced
into the mouth after padding the gums with a moist 4X4. The patient was noted to be edentulous on the maxillary segment and
had 5 chipped teeth on the mandibular segment. The Dedo laryngoscope was then advanced to the level of the cords which were
found to be normal. It was then gently retracted to view the surface of the epiglottis which was normal. It was then further
withdrawn to provide excellent visualization of the lingual surface of the epiglottis which is found to be grossly involved with the
mass which appeared consistent with squamous cell carcinoma. Of course the mass extended into the left aryepiglottic fold and
likely into the right aryepiglottic fold as well. The preepiglottic space was not involved, nor was the base of the tongue. The perform sinuses were then inspected with the Dedo; both were found to be normal, as well as the postcricoid space. At this
point, attention was turned to the esophagus. The Dedo was removed and the flexible esophagogastroduodenoscopy scope was inserted. Using insufflation, the scope was gently advanced throughout the length of the esophagus to the GE junction. There were
no lesions found in the esophagus so the scope was gently and atraumatically removed. The Dedo was then reinserted to expose
the lesion. The biopsy forceps were then used to take multiple biopsies, the first of which was sent for frozen section diagnosis. The remainder was sent for permanent pathology. A pledget was soaked in 1% lidocaine with epinephrine and placed over the biopsy
site while we awaited the results of the frozen section. The Dedo was then withdrawn while awaiting this. The pledget
was then removed. The area was inspected one final time for hemostasis and found to be dry. The shoulder roll was removed and
the patient was returned to the care of the anesthesia team for wake up. This proceeded uneventfully and he was extubated in
stable condition.
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