31375 Partial laryngectomy (hemilaryngectomy); laterovertical

Name of the Procedure:

Partial laryngectomy (hemilaryngectomy); laterovertical

Summary

A partial laryngectomy, also known as a hemilaryngectomy, is a surgical procedure to remove a portion of the larynx (voice box) while preserving as much of the structure and function as possible. The laterovertical approach specifically focuses on removing parts from one side of the larynx.

Purpose

Partial laryngectomy targets treatment of laryngeal cancer, particularly when the cancer is limited to one side of the larynx. The goal is to eradicate the cancer while maintaining the patient's ability to speak, breathe, and swallow normally.

Indications

• Diagnosed laryngeal cancer confined to one side of the larynx.
• Patients ineligible for a full laryngectomy or nonsurgical treatments.
• Preservation of voice and respiratory function is desired.

Preparation

• Fasting for 8 hours prior to surgery.
• Adjustments to any medications as instructed by the healthcare provider.
• Pre-operative assessments including blood tests, imaging studies like CT or MRI, and possibly a biopsy.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the neck to access the larynx.
3. The surgeon removes the affected part of the larynx from the side (laterovertical).
4. Special surgical instruments and possibly an endoscope are used for precision and visibility.
5. The remaining structures of the larynx are preserved and repaired to maintain function.
6. The incision is closed with sutures, and a drainage tube may be placed to remove excess fluids.

Duration

The procedure typically takes about 4 to 6 hours.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Head and neck surgeon or otolaryngologist (ENT specialist)
• Anesthesiologist
• Surgical nurses
• Potentially, a speech-language pathologist (SLP) for post-operative rehabilitation planning

Risks and Complications

• Infection at the surgical site
• Bleeding or excessive swelling
• Difficulty swallowing or changes in voice quality
• Aspiration (food or liquid entering the airway)
• Airway obstruction
• Need for a tracheostomy in some cases

Benefits

• Removal of cancerous tissue
• Potentially avoiding the need for a full laryngectomy
• Preservation of speech and swallowing functions
• Improved chances of long-term cancer remission

Recovery

• Hospital stay ranging from a few days to a week.
• Post-operative care including wound dressing changes, pain management, and possibly a temporary feeding tube.
• Follow-up appointments to monitor healing and remove any drains or sutures.
• Speech therapy to aid in voice recovery.
• Gradual return to normal activities over several weeks, with specific guidelines on diet and vocal rest.

Alternatives

• Radiation therapy or chemotherapy, either alone or in combination.
• Full laryngectomy, which would involve removal of the entire larynx.
• Endoscopic laser surgery.
• Pros and cons include the difference in recovery times, risk profiles, and potential impact on quality of life (e.g., speaking and breathing functions).

Patient Experience

• The patient will be under anesthesia during the procedure, ensuring no pain is felt.
• Post-operative discomfort, such as soreness and difficulty swallowing, is common.
• Pain is typically managed with medications.
• The patient might experience changes in voice quality and could need speech therapy.
• Emotional and psychological support may be beneficial as the patient adjusts to changes in voice and possibly lifestyle.