Background and Rationale:

High-definition white light endoscopy (WLE) remains the standard-of-care for evaluating early laryngeal lesions, providing high-resolution surface and color information. However, WLE has well-recognized limitations. Early dysplasia may lack clear surface changes, while benign inflammatory lesions can mimic malignancy, resulting in sensitivity values as low as 51% in some studies.

The quintessential clinical dilemma is vocal fold leukoplakia—a descriptive term encompassing a wide histopathological spectrum, from benign hyperkeratosis to invasive squamous cell carcinoma (Piazza et al., 2010). Because WLE cannot reliably predict histopathological severity, management remains highly controversial. Some clinicians advocate routine surgical biopsy due to the risk of occult carcinoma, while others support conservative observation in low-risk cases (Peretti et al., 2017). This uncertainty results in a significant healthcare burden driven by repeated surveillance, unnecessary biopsies, and the risk of delayed diagnosis.

Role of Narrow Band Imaging (NBI):

NBI has emerged as a critical adjunct by enhancing the visualization of intraepithelial papillary capillary loops (IPCLs), thereby improving the detection of neoplastic vascular patterns (Piazza and Peretti, 2012). Recent literature demonstrates a strong correlation between NBI vascular patterns and histopathological outcomes, improving diagnostic precision and aiding in the prediction of malignant transformation in leukoplakia (Lin et al., 2020; Pietruszewska et al., 2021).

Despite its growing acceptance, NBI is not a panacea. It remains highly dependent on operator expertise and is subject to diagnostic pitfalls, particularly in post-radiotherapy mucosa and lesions with deep submucosal extension.

Background: Tracheal or stomal stenosis is a dreaded complication after tracheotomy. The incidence of tracheal stenosis after tracheotomy reaches up to 21% in certain series. The inferiorly based flap tracheotomy, known as Björk flap tracheotomy, was first described by Björk in 1952 following a patient mortality from a displaced cannula. It involves a flap of the anterior tracheal wall secured to the inferior edge of the skin incision by a non-absorbable silk suture. The Björk flap tracheotomy aims to lower the shearing pressures created by movement of the tracheotomy tube during coughing and breathing. Also, its resulting tract matures quickly. Furthermore, the trachea is pulled up to the skin and fastened even if the stoma has not been fully developed. This makes the tracheotomy tube changes safer and simpler.

Only 11% of Björk flap tracheotomy cases show narrowing of the tracheal lumen. The narrowing never exceeds 50% of the lumen. Furthermore, Björk flap tracheotomy cases show a decreased rate of stomal stenosis than the conventional tracheotomy ones. The chances of tracheal or stomal stenosis are higher in conventional tracheotomy because of the higher risk of stomal injury. Furthermore, the likelihood of peristomal granulation is lower in the Björk flap tracheotomy. These granulations are less likely to block the flap-based mature stoma.

Methodology: We will review the pathogenesis of the post tracheotomy tracheal stenosis. Then we will describe the surgical technique, tips and pearls of the Björk flap tracheotomy, detailing the differences between it and the conventional tracheotomy. We will underline the advantages of the Björk flap tracheotomy, especially in the prevention of tracheal stenosis.

Conclusion: Björk flap tracheotomy is much safer than the conventional tracheotomy. It shows fast recovery and is associated with less incidence of tracheal stenosis. The inverted U-shaped flap preserves the tracheal cartilage and maintains the lumen after tracheotomy. Björk flap tracheotomy is not far from becoming recommended as a best practice technique to lower the incidence and severity of post tracheotomy tracheal stenosis.

this is a course about Current Concepts in Vocal Fold Paralysis

Background, Description, and ObjectivesSecond branchial arch cysts are the most common congenital cystic lesions of the lateral neck. They arise from incomplete obliteration of the second branchial cleft during embryological development and usually present as painless lateral cervical swellings. Differential diagnosis may be challenging, particularly in adults, where cystic metastatic lymph nodes should always be excluded. Complete surgical excision remains the definitive treatment and requires detailed knowledge of cervical anatomy to avoid injury to adjacent neurovascular structures and to prevent recurrence.

This instructional course will review the embryology, clinical presentation, imaging characteristics, differential diagnosis, and surgical anatomy of second branchial arch cysts. Surgical techniques, operative tips, potential complications, and postoperative outcomes will be discussed through a case-based approach.

The objectives are to improve diagnostic accuracy, optimize surgical planning, enhance operative safety, and reduce recurrence and complications.