Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope
CPT4 code
Name of the Procedure:
Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope
Common Names: Direct laryngoscopy, Vocal cord stripping, Tumor excision from vocal cords
Summary
This procedure involves using a special instrument known as a laryngoscope to view the vocal cords and surrounding areas directly. It allows the surgeon to remove tumors or abnormal growths and to strip the vocal cords or epiglottis if necessary, using an operating microscope or telescope for enhanced precision.
Purpose
Addresses: Tumors, lesions, abnormal growths, and other structural abnormal conditions in the vocal cords or epiglottis. Goals: To remove the problematic tissue, alleviate symptoms, restore normal function of the vocal cords, and prevent further complications.
Indications
Symptoms/Conditions: Persistent hoarseness, voice changes, difficulty swallowing, breathing difficulties, unexplained throat pain, or the presence of suspicious lesions or tumors in the throat. Patient Criteria: Individuals with confirmed or suspected vocal cord or epiglottic tumors, abnormal tissue growths, or structural abnormalities requiring surgical intervention.
Preparation
Pre-procedure Instructions: Fasting for at least 6-8 hours prior to the procedure, adjusting medications as directed by the physician, arranging for someone to drive the patient home. Diagnostic Tests/Assessments: Preoperative blood tests, imaging studies (e.g., CT, MRI), and possibly a biopsy to evaluate the nature of the lesion.
Procedure Description
Steps:
- The patient is administered general anesthesia to ensure they are asleep and pain-free.
- The surgeon inserts a laryngoscope into the patient's throat to gain direct access to the vocal cords and surrounding structures.
- Using an operating microscope or telescope for enhanced visualization, the surgeon locates and excises the tumor or abnormal tissue.
- The surgeon may strip the vocal cords or epiglottis if necessary to remove unhealthy tissue and promote healing.
- The laryngoscope is carefully removed, and the patient is monitored during recovery from anesthesia. Tools/Equipment: Laryngoscope, operating microscope or telescope, surgical instruments for excision. Anesthesia: General anesthesia.
Duration
Typically lasts between 30 minutes to 2 hours, depending on the complexity of the case.
Setting
Performed in an operating room within a hospital or a specialized surgical center.
Personnel
Involved Healthcare Professionals:
- Surgeons specialized in ENT (Ear, Nose, and Throat)
- Anesthesiologists
- Surgical nurses
- Operating room technicians
Risks and Complications
Common Risks: Sore throat, temporary hoarseness, minor bleeding, swelling. Rare Risks: Infection, significant bleeding, vocal cord damage, aspiration, anesthesia-related complications. Complication Management: Monitoring by healthcare professionals, prescribed medications, or additional treatments if necessary.
Benefits
Expected Benefits: Relief from symptoms, improved voice quality, resolution of the underlying problem, prevention of serious complications. Realization of Benefits: Improvements may be noticeable immediately post-surgery, with full benefits realized as healing occurs over the following weeks.
Recovery
Post-procedure Care/Instructions: Resting the voice, avoiding strenuous activities, following a soft diet, taking prescribed medications for pain and inflammation. Expected Recovery Time: Typically 1-2 weeks, with follow-up visits scheduled to monitor healing and progress.
Alternatives
Other Treatment Options: Voice therapy, laser surgery, conservative management with medication, observational monitoring for minor lesions. Pros and Cons of Alternatives: Voice therapy may be less invasive but might not be effective for significant lesions. Laser surgery offers precision but may not suit all cases. Conservative management avoids surgery but could delay definitive treatment.
Patient Experience
What to Expect During and After: The patient will be under general anesthesia and won't feel the procedure. Post-surgery, there may be throat discomfort, a temporary change in voice, and mild pain managed with medication. Comfort measures include rest, hydration, and avoiding irritants like smoking.