Annals of Otology, Rhinology & Laryngology 119(9):573-577. Ci 20I0 Annals PublishingCompany.All rights reserved. Hypopharyngeal Extrusion of 2.5 Feet (76 em) of _ Polytetrafluoroethylene (Gore-Tex): Initial Laser-Assisted Office-Based Removal and Micropharyngeal Completion Steven Feinberg, MD; Gerardo Lopez-Guerra, MD; Steven M. Zeitels, MD Extrusion of an implant after medialization laryngoplasty is unusual and warrants removal. Most commonly, it extrudes through the laryngeal introitus, but rarely, it extrudes through the pyriform sinus. A case report in which 2.5 feet (76 cm) of polytetrafluoroethylene(Gore-Tex) was removed from an 80-year-old female patient is presented to evaluate factors that led to this surgical complication and strategies that solved the problem. Because of the patient's multiple medical problems, initial removal ofthe foreign body was attempted in the office with topical anesthesia. When the Gore-Tex was noted to be lodged in the laryngeal parenchyma, it was severed at the edge of the pyriform sinus to stabilize the airway. SUbsequently, microlaryngoscopic-controlled completion removal was done in the operating room with general anesthe- sia. The patient healed uneventfully with no further sequelae. Analysis of this case illustrates a number of factors lead- ing to a rare iatrogenic foreign body complication. Office-based removal of the Gore-Tex implant evolved into a unique scenario in which the rapid use of a fiber-based laser to divide the foreign body facilitated stabilizing the airway to allow for elective completion removal in a controlled fashion. Key Words: Gore-Tex, KTP laser, laryngoplasty,larynx, laser, polytetrafluoroethylene,vocal cord, vocal cord paralysis, vocal fold. HISTORY AND PRESENTATION A female patient underwent high-dose radiothera- py in the 1930s for thymus enlargement, was subse- quently treated for metastatic papillary thyroid can- cer (1958), and was disease-free for 50 years. In the 1970s, a right vocal fold paralysis was noted, and in 2002, a surgeon performedrnedialization laryn- goplasty with polytetrafluoroethylene <yore-Tex) at another institution. Because of slowly progressive postoperative hoarseness and dysphagia, the patient sought another opinion at our institution in March 2008, at 80 years of age. Her laryngoscopic exami- nation revealed an excessive amount of exudate in Fig.I.A) Distal-chip flexible examination of laryngopharynx and larynx shows copious secretions overlying foreign bodyin right pynfonn sinus.B) After suctioning of secretions, it appears as if there is food foreign body lodged ill rightpyrifonnsinus. From theCenter for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital (all authors), andthe Department of Surgery, Harvard Medical School (Lopez-Guerra, Zeitels), Boston, Massachusetts. Dr Feinberg is currently aiHoag Voice and Swal- lowing Center, Newport Beach, California. Presented at the meeting of theAmerican Broncho-Esophagological Association, Phoenix, Arizona, May 28·29, 2009. Recipient of the Presidential Citation for Foreign Body Management. Correspondence: Steven M. Zeitels, MD, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, OneBowdoin Square. 11th Floor, Boston, MA 02114. 573