Topical anesthesia refers to the loss of sensation confined to mucosal surfaces (as when pontocaine, benzocaine, or lidocaine is applied to the surface).

TA-only Paresis before and after Voice Gel Injection

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TA weakness, intact LCA + PCA (1 of 5)

TA weakness indicated by bowed margin and “spaghetti-linguini” difference between the cords. Medial turning of vocal process (arrow) suggests intact LCA; abducted position suggests intact PCA function. Blood is from cricothyroid membrane puncture to instill topical anesthesia.

Prephonatory instant (2 of 5)

Before voice gel injection at prephonatory instant. Wasting of left cord (right of photo), and capacious ventricle on the left (right of photo) clearly evident.

Gel injection (3 of 5)

At beginning of voice gel injection (needle at white arrow).

Straight vocal cord margin (4 of 5)

At conclusion of voice gel, note straight left cord margin (right of photo). Compare with photos 1 and 3.

Phonation (5 of 5)

Phonation after injection complete. Voice dramatically strengthened. Compare with photo 2.

Thulium Laser Surgery, With Local Anesthetic Injection, to Treat Leukoplakia

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Leukoplakia, about to be treated with laser (1 of 4)

Leukoplakia of the vocal cords in a patient radiated years earlier for glottic cancer. This disease is mostly benign, but foci of carcinoma-in-situ have also been removed twice in the operating room, yet with rapid return of leukoplakia. The patient has had no glottic voice. In an effort to avoid total laryngectomy, we are managing these visual abnormalities with the thulium laser in an outpatient videoendoscopy room.

Injection of local anesthetic (2 of 4)

Since this patient cannot tolerate aggressive laser therapy with topical anesthesia alone, we are here adding injection of local anesthetic. Note the blanching of tissue surrounding the needle.

Injection of local anesthetic (3 of 4)

Further injection of the local anesthetic.

Right after thulium laser treatment (4 of 4)

At the completion of aggressive laser coagulation of abnormal tissue. Compare with photo 1. The patient will return in a month for additional laser treatment as indicated.