Laryngectomy; total, without radical neck dissection
CPT4 code
Name of the Procedure:
Total Laryngectomy (without radical neck dissection)
Summary
Total laryngectomy is a surgical procedure in which the entire larynx (voice box) is removed. This operation is typically done to treat advanced cancer of the larynx. The surgery involves removing the larynx and creating a permanent stoma (breathing hole) in the neck.
Purpose
Total laryngectomy is performed to treat advanced laryngeal cancer. The goals of the procedure are to remove the cancerous tissue, prevent the spread of the disease, and improve the patient's quality of life by alleviating symptoms such as difficulty breathing and swallowing.
Indications
- Advanced laryngeal cancer
- Recurrent laryngeal cancer after radiation or chemotherapy
- Severe damage to the larynx due to other conditions
Patient criteria:
- Diagnosed with stage III or IV laryngeal cancer
- Good overall health to tolerate major surgery
Preparation
- Fasting for at least 8 hours before surgery
- Discontinuing certain medications as advised by the doctor
- Undergoing diagnostic tests, such as imaging scans (CT, MRI) and biopsy
Procedure Description
- Anesthesia is administered to put the patient to sleep.
- An incision is made in the neck to access the larynx.
- The entire larynx is removed, including the vocal cords.
- A permanent stoma (breathing hole) is created in the neck for the patient to breathe through.
- The incision is closed with sutures or staples.
- A tracheostomy tube is placed in the stoma to keep the airway open during the initial healing period.
Tools and Equipment:
- Surgical scalpels and instruments
- Suction devices
- Anesthesia machine
- Tracheostomy tube
Duration
The procedure typically takes about 5 to 9 hours.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Otolaryngologist (ENT surgeon)
- Anesthesiologist
- Surgical nurse
- Operating room technician
Risks and Complications
- Infection
- Bleeding
- Swelling that can obstruct breathing
- Difficulty swallowing
- Permanent loss of natural voice
- Complications related to anesthesia
Benefits
- Removal of cancerous tissue
- Improved breathing and swallowing
- Reduced risk of cancer recurrence
Recovery
- Hospital stay of 7 to 14 days
- Monitoring of the stoma and tracheostomy tube
- Instructions on stoma care and use of the tracheostomy tube
- Gradual return to normal activities over several weeks to months
- Speech rehabilitation with a speech-language pathologist
- Follow-up appointments to monitor recovery and detect any recurrence
Alternatives
- Radiation therapy
- Chemotherapy
- Partial laryngectomy
- Combination of radiation and chemotherapy
Pros and Cons of Alternatives:
- Less invasive but may be less effective for advanced cancer
- Partial laryngectomy preserves some natural voice but may not remove all cancer
- Radiation and chemotherapy can have significant side effects
Patient Experience
During the Procedure:
- The patient will be under general anesthesia and won't feel anything.
After the Procedure:
- Initial soreness and discomfort at the surgical site
- Learning to adjust to breathing through the stoma
- Speech rehabilitation will be needed since the natural voice is lost permanently
- Pain management with medications
- Gradual improvement in breathing and swallowing functions