31545 Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s)

Name of the Procedure:

Direct Operative Laryngoscopy with Operating Microscope or Telescope, Submucosal Removal of Non-neoplastic Lesion(s) of Vocal Cord, Reconstruction with Local Tissue Flap(s)

Summary

This procedure involves the use of an operating microscope or telescope to directly visualize the vocal cords and surgically remove non-cancerous (non-neoplastic) lesions beneath the mucous membrane. The affected area is then reconstructed using tissue flaps from nearby areas.

Purpose

This procedure addresses benign lesions on the vocal cords that can cause voice changes, breathing difficulties, or discomfort. The goal is to remove these lesions and restore normal vocal cord function, improving the patient's voice and reducing symptoms.

Indications

• Hoarseness or changes in voice quality
• Difficulty breathing or swallowing due to vocal cord lesions
• Non-cancerous vocal cord lesions identified through imaging or examination
• Patients unresponsive to less invasive treatments

Preparation

• Fasting for at least 6-8 hours before the procedure
• Review and adjustment of current medications, especially blood thinners
• Pre-procedure imaging studies, such as a laryngoscopy, to assess the lesion

Procedure Description

1. The patient is placed under general anesthesia.
2. A laryngoscope is introduced into the patient's throat to visualize the vocal cords.
3. An operating microscope or telescope is used to enhance the view of the vocal cords.
4. Special micro-instruments are utilized to meticulously remove the non-cancerous lesions beneath the mucous membrane of the vocal cords.
5. Local tissue flaps are used to reconstruct the vocal cords to ensure optimal healing and function.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity and extent of the lesions.

Setting

The procedure is performed in a hospital operating room or a surgical center.

Personnel

• Otolaryngologist (ENT surgeon)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Bleeding
• Infection
• Scarring or damage to the vocal cords
• Changes in voice (temporary or permanent)
• Breathing difficulties (rare)
• Reaction to anesthesia

Benefits

• Removal of non-cancerous lesions on the vocal cords
• Improved voice quality
• Relief from symptoms such as difficulty breathing or swallowing
• Restoration of normal vocal cord function

Recovery

• Post-procedure monitoring in a recovery room
• Instructions for voice rest for a specified period
• Avoiding strenuous activities and heavy lifting
• Follow-up appointments to monitor healing and vocal cord function
• Expectation of some discomfort or mild pain, manageable with prescribed pain medications

Alternatives

• Voice therapy for mild lesions
• Observation and monitoring for lesions that do not cause symptoms
• Non-operative treatments (e.g., corticosteroid injections)
• The pros of the described procedure include definitive removal and immediate relief of symptoms, while cons might include the risks associated with surgery and anesthesia.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-procedure, the patient may experience throat soreness, hoarseness, or mild discomfort, which can be managed with pain medications. Voice rest and following post-operative care instructions will aid in a smooth recovery process.