Laryngoplasty, not otherwise specified (eg, for burns, reconstruction after partial laryngectomy)
CPT4 code
Name of the Procedure:
Laryngoplasty (not otherwise specified)
- Common name: Laryngoplasty
- Medical term: Laryngoplasty (NOS), Laryngeal Reconstruction
Summary
Laryngoplasty is a surgical procedure performed to reconstruct or repair the larynx (voice box). It can be necessary due to burns, injury, or after partial laryngectomy, which is the removal of a part of the larynx due to cancer or other disease.
Purpose
Laryngoplasty addresses various conditions affecting the larynx, including structural damage from burns, trauma, or surgical removal due to tumors. The goals are to restore normal breathing, protect the airway, re-establish normal swallowing, and improve or preserve voice quality.
Indications
- Breathing difficulties due to laryngeal obstruction
- Voice impairment following partial laryngectomy
- Laryngeal burns or injuries
- Structural abnormalities or congenital defects
- Difficulty swallowing affecting normal nutrition and hydration
Preparation
- Patients may need to fast for 8-12 hours before the procedure.
- Medication adjustments per surgeon's advice.
- Preoperative assessments include imaging studies like CT scans, laryngoscopy, and sometimes a biopsy.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incision: The surgeon makes an incision to access the larynx.
- Reconstruction: The damaged parts of the larynx are repaired or reconstructed using grafts from other body parts or synthetic materials.
- Closure: The incision is closed with sutures.
- Monitoring: The patient is monitored post-operatively for any immediate complications.
Common tools and equipment include laryngoscopes, microinstruments, and sometimes, a laser.
Duration
The procedure typically takes 1-3 hours, depending on the extent of the repair needed.
Setting
Laryngoplasty is performed in a hospital, usually in an operating room equipped for advanced airway surgery.
Personnel
- Surgeon (specialist in ENT or head and neck surgery)
- Anesthesiologist
- Surgical nurses
- Possibly a speech therapist for post-operative voice rehabilitation
Risks and Complications
- Common risks: Bleeding, infection, scarring, and temporary difficulty swallowing.
- Rare risks: Airway obstruction, need for a tracheostomy, nerve damage causing voice changes, or long-term swallowing difficulties.
- Complications are managed with medications, additional surgical interventions, or airway support as needed.
Benefits
- Restored or improved breathing and swallowing functions
- Preservation or enhancement of voice quality
- Prevention of more serious airway complications
Benefits often become apparent within weeks to months, with continued improvement over time.
Recovery
- Hospital stay of 1-2 days post-surgery.
- Patient may require a temporary nasogastric tube for feeding.
- Avoid strenuous activity and heavy lifting for several weeks.
- Speech therapy sessions to help with voice recovery.
- Follow-up appointments for monitoring healing and addressing any issues.
Alternatives
- Non-surgical options like voice therapy or use of a voice prosthesis.
- Other surgical procedures like tracheostomy or more extensive laryngeal surgeries.
- Each alternative varies in invasiveness, risk, and effectiveness based on individual patient needs.
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel anything. Post-procedure, the patient may experience some throat discomfort, difficulty swallowing, and hoarseness. Pain is usually managed with prescribed medications, and additional support is provided for diet and voice rehabilitation.
Comfort measures include:
- Adequate pain management
- Hydration and nutrition support
- Encouragement and psychological support to aid in recovery.