Key Points

• The use of the operating microscope during laryngoscopy under anesthesia allows for precise assessment and treatment of many benign and malignant laryngeal lesions. However, because of the size and axis of vision, the operating microscope has some distinct limitations in its capacity to visualize certain regions.
• With the advancement of fiberoptic technology, rigid endoscopes have assumed a greater diagnostic and therapeutic role. Excellent optical resolution, combined with the ability to magnify and digitally record the images, has resulted in increasing reliance on this technology in sinonasal surgery, otology, neurotology, and facial plastic and reconstructive surgery.
• Rigid endoscopes offer multiple viewing angles and allow for accurate visualization of areas that can be difficult to assess with standard techniques. Evaluation of the laryngeal surface of the epiglottis, the anterior commissure, the laryngeal ventricle, and the subglottic region is greatly facilitated by the use of rigid endoscopes.
• Rigid endoscopes that are most commonly used for laryngeal assessment are 24 cm long and 5 mm in diameter, with angles of vision of 0, 30, 70, and 120 degrees. Zero- and 30-degree scopes offer excellent magnified views of the superior laryngeal surfaces, whereas the more angled scopes offer excellent views of those areas typically hidden from view by overlying structures.
• Treatment strategies for benign lesions of the laryngeal mucosa that have failed previous medical or conservative measures typically involve removal of involved pathologic tissue with maximal preservation of normal tissues. The improved ability to identify the exact extent of disease can minimize removal of normal tissue, ensure a complete resection, and thus minimize patient morbidity by preserving voice function.
• Endoscopic transoral laser resection, partial laryngeal surgery, and nonsurgical radiation- and chemotherapy-based protocols are all designed to avoid total laryngectomy in appropriate patients and thus maintain normal voice production. Rigid endoscopic assessment of the extent of malignancy allows for more accurate stratification of patients and better assessment of suspected recurrences, resulting in more appropriate treatment selection.