Figure 3.
A case of “navigating” an unfavorable supralaryngeal tract. Clinical presentation was of new-onset hoarseness with flexible laryngoscopic finding of a left anterior vocal lesion in a patient whose T1 glottic cancer had been treated with radiotherapy some years previously. The patient was intubated with video laryngoscopy using a gum-elastic bougie and a C-MAC video laryngoscope (Karl Storz Endoscopy, Tuttlingen, Germany). However, line-of-sight surgical access to the lesion could not be established due to the presence of retrognathia and fibrotic neck tissues (i.e. pathologies within the suprahyoid tissue envelope of the supralaryngeal tract). The lesion was accessed and biopsied using a combination of C-MAC laryngoscopy to negotiate and retract tissues, and flexible endoscopy to access and biopsy the lesion.