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Easy way of taking biopsy from growth hypopharynx
Dr. T. Balasubramanian M.S. D.L.O.
Introduction: Malignant growth are common in the hypo pharyngeal area. This area includes the right and left pyriform fossae, and the post cricoid region. Malignant growth are fairly common in this area. This area is also richly endowed with lymphatics and hence tumor spread is really rapid from this area.
Formerly biopsy from this area was taken using a direct laryngoscope. This procedure was safely performed under topical anaesthesia using 4% xylocaine spray. During this procedure the patient is very uncomfortable and needs to be sedated. It is also fraught with danger because patients in this age group have fairly advanced cervical spine spondylosis.
In the clipping below the whole procedure is comfortably performed using a 30% 4 mm nasal endoscope and a giraffe forceps which are commonly used for endoscopic sinus surgery.
The patient's oral cavity is sprayed with 4% xylcaine and the patient is instructed to hold it inside the mouth for full 5 minutes after which it may be spitted out. 30 degree 4 mm nasal endoscope is held in the non dominant hand connected to endoscopic camera. The endoscope is held in such a way that the cut side of the tip is pointing downwards.
The tongue of the patient is proturded and held under a piece of gauze by the assistant. The rigid endoscope is slide gently under the soft palate and the hypopharynx is clearly visualised. Biopsy can be taken with a giraffe forceps which is again a common FESS instrument.
1. Easy to perform even under out patient settings
2. Comfortable for the patient
3. Sedation not required
4. If necessary local anesthesia could also be avoided
5. Safe for the patient
6. The complete extent of growth can be assessed
7. Vocal fold mobility can be ascertained with certainty
Difficult to perform in patient with trismus
Video showing the procedure being performed