A Method of Transoral Finger Dissection for a Giant Epiglottic Lipoma

Figure 3

Illustrations and a photograph of transoral finger dissection. (a) After a tracheotomy and cessation of microscopic laryngeal surgery, the patient’s mouth was opened with a large mouth gag (MG). Under macroscopic observation while maintaining the airway with a tracheostomy tube (TT), the epiglottic tumor (ET) was pulled into the oral cavity by grasping its frontal wall with forceps. The root of the lipoma attached to the epiglottis was slightly incised using a scalpel (arrows). (b) Traction was placed on the lipoma while simultaneously elevating the epiglottis and larynx to generate a spatial gap between ET and epiglottic cartilage. ET was blindly separated from epiglottic cartilage using the surgeon’s index finger inserted into the gap. Because mucosal bundles covering ET converge to the lateral sides of the epiglottic attachment, they were cut using an electric knife (double-headed arrow). Consequently, ET was dissected en bloc. (c) ET was pulled out of the oral cavity and was manipulated using the surgeon’s index finger.

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