Abstract
Direct laryngoscopy dates back to the late nineteenth century: early surgeons realised that a direct line of sight to the larynx would facilitate trans-oral surgery on the vocal folds. In the last 130 years, many advances have occurred, including the introduction of microscopes, suspension laryngoscopy, microinstruments, powered instruments, endoscopes, lasers and other operating tools. For the surgeon learning about all forms of laryngeal surgery, the practice of ‘cold steel’ laryngeal surgery is possibly the most important skill that a laryngologist can develop. From there, other instruments can be introduced.
Alongside developments in surgical instrumentation, advances in our understanding of the microanatomy of the vocal folds have facilitated the development of more refined surgical procedures. In particular, the concept of the ‘body and cover’ theory, and the understanding of the importance of the superficial lamina propria in the pliability of the vocal folds, has allowed surgical techniques that retain the mucosal wave post-operatively.
In this overview, we describe the history of the development of ‘cold steel’ laryngeal surgery, along with some of the instruments that have been introduced in the last few decades.
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Costello, D., Gibbins, N., Cherko, M. (2022). Microphonosurgery Using Cold Steel. In: Remacle, M., Eckel, H.E. (eds) Textbook of Surgery of Larynx and Trachea. Springer, Cham. https://doi.org/10.1007/978-3-031-09621-1_5
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