Partial laryngectomy (hemilaryngectomy); antero-latero-vertical
CPT4 code
Name of the Procedure:
Partial Laryngectomy (Hemilaryngectomy); Antero-Latero-Vertical
Summary
A partial laryngectomy, specifically an antero-latero-vertical hemilaryngectomy, is a surgical procedure where part of the voice box (larynx) is removed. This technique aims to excise cancerous tumors while preserving as much of the larynx's function as possible.
Purpose
The procedure addresses laryngeal cancer, particularly when the tumor is localized and operable. The primary goal is to remove the cancerous tissue while preserving the patient's ability to speak and breathe normally.
Indications
- Diagnosed laryngeal cancer limited to one side of the larynx.
- Recurrent laryngeal cancer after radiation therapy.
- Moderate to severe dysphonia (voice changes) due to the tumor.
- Inspiratory stridor or difficulty breathing due to the tumor obstructing the larynx.
Preparation
- Preoperative assessment including physical examination, blood tests, imaging studies (CT, MRI, or PET scans), and direct laryngoscopy.
- Fasting for at least 8 hours before surgery.
- Adjustments or cessation of certain medications, as advised by the healthcare provider.
- Patient counseling on the procedural details, risks, and post-operative recovery.
Procedure Description
- After administering general anesthesia, the surgeon makes an incision in the neck to access the larynx.
- The larynx is partially exposed, and the affected, cancerous portion is carefully identified.
- Using specialized surgical instruments, the surgeon removes the diseased part of the larynx (antero-latero-vertical section) while preserving non-affected structures.
- Reconstruction may be performed to ensure that the remaining larynx can function properly for speech and breathing.
- The incision is closed, and a temporary tracheostomy may be placed to assist with breathing during the initial recovery phase.
Tools, Equipment, and Anesthesia
- Surgical instruments (scalpels, forceps, retractors).
- General anesthesia.
- Potential use of a surgical microscope for meticulous dissection.
Duration
The procedure typically takes between 2 to 4 hours, depending on the complexity of the case.
Setting
This procedure is performed in a hospital operating room.
Personnel
- Head and neck surgeon (otorhinolaryngologist).
- Anesthesiologist.
- Surgical nurses and assistants.
- Postoperative care team.
Risks and Complications
- Bleeding or hematoma formation.
- Infection at the surgical site.
- Vocal changes or hoarseness.
- Swallowing difficulties.
- Airway complications requiring prolonged tracheostomy.
Benefits
- Removal of cancerous tissue, potentially curing localized laryngeal cancer.
- Preservation of significant laryngeal function for speaking and breathing.
- Lower complication rates compared to total laryngectomy.
Recovery
- Hospital stay for approximately 5 to 10 days post-surgery.
- Initial use of a tracheostomy tube, typically removed after a few days once swelling decreases.
- Speech therapy to assist with voice recovery.
- Regular follow-up appointments to monitor healing and cancer status.
- Temporary dietary adjustments to aid swallowing.
Alternatives
- Total laryngectomy, which removes the entire larynx but may have more significant impacts on speech and breathing.
- Radiation therapy, which may be less invasive but carries risks of recurrence and side effects.
- Chemotherapy, often used in conjunction but may not be effective alone for localized tumors.
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel any pain. Postoperatively, there may be discomfort at the incision site, temporary hoarseness, and difficulty swallowing, all of which are managed with appropriate pain medication and supportive therapies. Full recovery and adjustment to any changes in voice and swallowing function may take several weeks.