Larengolojide Ofis Uygulamaları
Özet
Larengolojide ofis uygulamaları, endoskopik sistemlerdeki teknolojik ilerlemeler ve topikal anestezi yöntemlerinin gelişmesiyle son dönemde popülerlik kazanmıştır. Günümüzde larengeal işlemlerin yaklaşık %15'i ofis şartlarında yapılabilmektedir. Bu uygulamaların en önemli avantajları arasında genel anestezi risklerinden uzaklaşılması, maliyetlerin düşmesi, tanı ve tedavi süreçlerinin hızlanması ve hastaların işlem günü günlük hayatlarına dönebilmesi yer alır. Ancak anksiyete, kardiyolojik hastalıklar, şiddetli öğürme refleksi ve kanama diatezi gibi durumlar bu işlemler için kontrendikasyon oluşturmaktadır. Temel ofis uygulamaları transnazal özefagoskopi (TNÖ), biyopsi, anjiyolitik lazer cerrahileri (KTP, PDL, mavi lazer), dolgu materyalleri (hiyalüronik asit vb.) ile enjeksiyon larengoplastiler, botulinum toksin/steroid enjeksiyonları, larengotrakeal stenoz açılımı ve trakeaözefageal fistül açılmasını kapsamaktadır. Özellikle fonksiyonel ses cerrahilerinde hastanın uyanık ve koopere olması, işlem esnasında anlık sonuç alma ve müdahale etkinliğini değerlendirme fırsatı sunar. Nadiren de olsa aspirasyon, kanama, larengospazm ve havayolu darlığı gibi komplikasyonlar gelişebileceğinden preoperatif değerlendirme ve postoperatif takip (özellikle işlem sonrası 1-2 saat açlık) büyük önem taşımaktadır. Sonuç olarak, gelişen teknolojiyle birlikte ofis uygulamaları, düşük komplikasyon oranları ve yüksek hasta konforuyla larengolojideki yerini sağlamlaştırmaktadır.
Office-based procedures in laryngology have recently gained popularity due to technological advancements in endoscopic systems and improvements in topical anesthesia methods. Today, approximately 15% of laryngeal procedures can be safely performed under office conditions. The primary advantages of these procedures include avoiding the risks and complications of general anesthesia, reducing costs, shortening diagnosis and treatment pathways, and allowing patients to return to their daily routines on the same day. However, conditions such as severe anxiety, cardiac history, an overactive gag reflex, and bleeding diathesis constitute contraindications. Core office applications consist of transnasal esophagoscopy (TNE), cup-forcep biopsies, angiolytic laser surgeries (KTP, PDL, blue laser), injection laryngoplasty with temporary fillers (hyaluronic acid, etc.), botulinum toxin or steroid injections, laryngotracheal stenosis division, and secondary tracheoesophageal puncture. Particularly in functional voice surgeries, the patient remaining awake and cooperative provides a unique opportunity to evaluate the real-time efficacy of the intervention. Although rare, complications like aspiration, epistaxis, laryngospasm, and airway edema may occur; thus, careful preoperative evaluation and postoperative monitoring (including 1-2 hours of fasting) are essential. Consequently, office-based laryngology offers a safe, comfortable, and cost-effective paradigm with low complication rates.
Referanslar
Belafsky PC, Postma GN, Daniel E et al Transnasal esophagoscopy. Otolaryngol Head Neck Surg 2001;125:588–9.
Pynnonen MA, Schmalbach CE. Office-based Procedures in Otolaryngology. Otolaryngol Clin North Am. 2019 Jun;52(3):xv-xxx.
Filauro M, Vallin A, Fragale M et al . Office-based procedures in laryngology. Acta Otorhinolaryngol Ital. 2021;41(3):243-7.
Koufman JA. Introduction to office-based surgery in laryngology. Curr Opin Otolaryngol Head Neck Surg 2007;15(6):383-6.
Mathison CC, Villari CR, Klein AM, et al. Comparison of outcomes and complications between awake and asleep injection laryngoplasty: a case-control study. Laryngoscope 2009;119:1417–23.
Wellenstein DJ, Schutte HW, Takes RP et al. Office-Based Procedures for the Diagnosis and Treatment of Laryngeal Pathology. J Voice. 2018;32(4):502-13.
Cohen JT, Bishara T, Trushin V et al. Adverse Events and Time to Diagnosis of In-Office Laryngeal Biopsy Procedures. Otolaryngol Head Neck Surg 2018;159(1):97-101.
Anderson J, Bensoussan Y, Townsley R, et al. In-Office Endoscopic Laryngeal Laser Procedures: A Patient Safety Initiative. Otolaryngol Head Neck Surg 2018;159(1):136-42.
Tasli H, Birkent H, Karakoc O, et al. Optimal Position for Transnasal Flexible Laryngoscopy. J Voice 2020;34(3):447-50.
Ghodke A, Farquhar DR, Buckmire RAet al Office-based laryngology: Technical and visual optimization by patient-positioning maneuvers. Laryngoscope 2019;129(2):330-4.
Wang CP, Lee YC, Yang TL, et al. Application of unsedated transnasal esophagogastroduodenoscopy in the diagnosis of hypopharyngeal cancer. Head Neck 2009;31(2): 153-7.
Tatsumi Y, Harada A, Matsumoto T et al. Current status and evaluation of transnasal esophagogastroduodenoscopy. Dig Endosc. 2009;21(3):141-6.
Naidu H, Noordzij JP, Samim A, et al. Comparison of efficacy, safety, and cost-effectiveness of in-office cup forcep biopsies versus operating room biopsies for laryngopharyngeal tumors. J Voice. 2012;26(5):604-6.
Richards AL, Sugumaran M, Aviv JE, et al. The utility of office-based biopsy for laryngopharyngeal lesions: comparison with surgical evaluation. Laryngoscope 2015;125:909–12.
Cohen JT, Safadi A, Fliss DM et al. Reliability of a Transnasal Flexible Fiberoptic In-Office Laryngeal Biopsy. JAMA Otolaryngol Head Neck Surg. 2013;139(4):341–5.
Castillo Farías F, Barberá R, Cobeta I. Reply to letter regarding in-office cup biopsies for pharyngolaryngeal tumors. Head Neck 2016;38(11):1731-2.
Rosen CA, Amin MR, Sulica L et al. Advances in office-based diagnosis and treatment in laryngology. The Laryngoscope, 2009;119: 185-212.
Shah MD, Johns MM 3rd. Office-based laryngeal procedures. Otolaryngol Clin North Am. 2013;46(1):75-84.
Tibbetts KM, Simpson CB. Office-Based 532-Nanometer Pulsed Potassium-Titanyl-Phosphate Laser Procedures in Laryngology. Otolaryngol Clin North Am. 2019;52(3):537-57.
Zeitels SM, Akst LM, Burns JA, et al. Office-Based 532-nm Pulsed KTP Laser Treatment of Glottal Papillomatosis and Dysplasia. Annals of Otology, Rhinology & Laryngology. 2006;115(9):679-85.
Shoffel-Havakuk H, Sadoughi B, Sulica L, Johns MM 3rd: In-office procedures for the treatment of benign vocal fold lesions in the awake patient: A contemporary review. Laryngoscope 2019;129(9):2131-38.
Rees CJ, Postma GN, Koufman JA. Cost savings of unsedated office-based laser surgery for laryngeal papillomas. Ann Otol Rhinol Laryngol 2007;116:45–8.
Yung KC, Courey MS. The Effect of office-based flexible endoscopic surgery on hemodynamic stability. Laryngoscope. 2010;120(11):2231-6.
Morrison MP, O’Rourke A, Dion GR, et al. Hemodynamic changes during otolaryngological office-based flexible endoscopic procedures. Ann Otol Rhinol Laryngol 2012;121(11):714–8.
Tierney WS, Chota RL, Benninger MS, et al. Hemodynamic Parameters during Laryngoscopic Procedures in the Office and in the Operating Room. Otolaryngology–Head and Neck Surgery. 2016;155(3):4
Brunings W. Uber eine neue Behandl ungsmethode der Rekurrens lahmung. Verhandl Ver Dtsch Laryngol 17:93, 1911.
Sulica L, Rosen CA, Postma GN, et al. Current practice in injection augmentation of the vocal folds: indications, treatment principles, techniques, and complications. Laryngoscope 2010;120(2):319-25.
Verma SP, Dailey SH. Office-based injection laryngoplasty for the management of unilateral vocal fold paralysis. J Voice. 2014;28(3):382-6.
Upton DC, Johnson M, Zelazny SK, et al. Prospective evaluation of office-based injection laryngoplasty with hyaluronic acid gel. Ann Otol Rhinol Laryngol. 2013;122(9):541-6.
Wen MH, Cheng PW, Liao LJ, et al. Treatment outcomes of injection laryngoplasty using cross-linked porcine collagen and hyaluronic acid. Otolaryngol Head Neck Surg. 2013;149(6):900-6.
Bertroche JT, Radder M, Kallogjeri D et al. Patient-defined duration of benefit from juvederm (hyaluronic acid) used in injection laryngoplasty. Laryngoscope. 2019;129(12):2744-7.
Reiter R, Brosch S. Laryngoplasty with hyaluronic acid in patients with unilateral vocal fold paralysis. J Voice. 2012;26(6):785-91.
Kim DW, Kim EJ, Kim EN, et al. Human Adipose Tissue Derived Extracellular Matrix and Methylcellulose Hydrogels Augments and Regenerates the Paralyzed Vocal Fold. PLoS One. 2016;11(10):e0165265.
Lee M, Lee DY, Kwon TK. Safety of office-based percutaneous injection laryngoplasty with calcium hydroxylapatite. Laryngoscope. 2019;129(10):2361-65.
Kaderbay A, Righini CA, Castellanos PF et al: Office-based endoscopic botulinum toxin injection in laryngeal movement disorders. Eur Ann Otorhinolaryngol Head Neck Dis 2018;135(3):205-7.
Mortensen M. Laryngeal steroid injection for vocal fold scar. Curr Opin Otolaryngol Head Neck Surg. 2010;18(6):487-91.
Campagnolo AM, Tsuji DH, Sennes LU et al. Steroid injection in chronic inflammatory vocal fold disorders, literature review. Braz J Otorhinolaryngol 2008; 74:926–32.
Zietek E, Matyja G, Kawczyński M. Stenosis of the larynx and trachea: diagnostics and treatment. Otolaryngol Pol 2001;55:515–20.
Myer CM, O’Connor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 1994;103:319–23.
Hoffman MR, Coughlin AR, Dailey SH. Serial office-based steroid injections for treatment of idiopathic subglottic stenosis. Laryngoscope. 2017;127(11):2475-81.
Glazer TA, Meraj T, Lyden TH et al. In-Office Secondary Tracheoesophageal Puncture with Immediate Prosthesis Placement. Otolaryngol Head Neck Surg 2016;155(2):360-3.
Belafsky PC, Potsma GN, Koufman JA. Replacement of a failed tracheoesophageal puncture prosthesis under direct vision. Ear Nose Throat J 2001;80:862.
Fukuhara T, Fujiwara K, Nomura K et al. New method for in-office secondary voice prosthesis insertion under local anesthesia by reverse puncture from esophageal lumen. Ann Otol Rhinol Laryngol 2013;122(3):163-68.
