Arytenoidectomy or arytenoidopexy, external approach
CPT4 code
Name of the Procedure:
Arytenoidectomy or Arytenoidopexy, External Approach
Summary
Arytenoidectomy or arytenoidopexy are surgical procedures that involve the partial or complete removal (arytenoidectomy) or repositioning (arytenoidopexy) of the arytenoid cartilage in the larynx using an external surgical approach.
Purpose
These procedures address issues such as vocal cord paralysis, severe breathing problems, and laryngeal cancers. The primary goals are to improve airway patency, voice quality, and swallowing function.
Indications
- Vocal cord paralysis or immobility
- Bilateral vocal fold paralysis
- Severe respiratory distress caused by glottic insufficiency
- Laryngeal cancer or tumors
- Chronic aspiration or aspiration pneumonia Patients who do not respond to less invasive treatments or who have severe symptoms may be considered for the procedure.
Preparation
- Patients may be instructed to fast for at least 6-8 hours before surgery.
- Medications that thin the blood should be adjusted or stopped as per the doctor's advice.
- Pre-surgical evaluations such as laryngoscopy, imaging studies, and blood tests might be required.
- Smoking cessation is strongly advised before surgery.
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made in the neck to access the larynx.
- For arytenoidectomy, the surgeon removes part or all of the arytenoid cartilage.
- For arytenoidopexy, the surgeon repositions and secures the arytenoid cartilage to improve airway function.
- The incision is then closed with sutures, and a drain may be placed to prevent fluid accumulation.
- Postoperative care includes monitoring and managing pain.
Duration
The procedure typically takes about 2 to 3 hours, depending on the complexity and extent of the surgery.
Setting
This procedure is generally performed in a hospital operating room.
Personnel
- Head and neck surgeon or an otolaryngologist
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma formation
- Airway obstruction
- Aspiration pneumonia
- Voice changes or weakening
- Dysphagia (difficulty swallowing)
- Scar formation or keloid development Complications are managed through medications, additional treatments, and close postoperative monitoring.
Benefits
- Improved breathing and airway patency
- Enhanced voice quality
- Reduced risk of aspiration
- Increased quality of life and ability to perform daily activities Benefits may be noticed immediately or within weeks after recovery.
Recovery
- Patients are often required to stay in the hospital for 1 to 3 days post-surgery.
- Pain management includes medications and sometimes a temporary feeding tube.
- Voice rest is typically recommended for several days.
- Follow-up appointments will be scheduled to monitor recovery and address any issues.
- Full recovery usually takes about 4 to 6 weeks, with gradual return to normal activity.
Alternatives
- Voice therapy and swallowing therapy
- Less invasive procedures like vocal cord injection or medialization thyroplasty
- Tracheostomy for severe cases The pros and cons of these alternatives depend on the severity of the condition and the patient's overall health.
Patient Experience
Patients might experience discomfort and pain during and after the procedure, which is managed through pain relief medications. They may need assistance with eating and speaking for a short period. The healthcare team will ensure the patient's comfort and provide detailed instructions for home care to promote healing and reduce infection risks.