Name of the Procedure:

Laryngoscopy, Direct Operative, with Arytenoidectomy; with Operating Microscope or Telescope

Summary

Laryngoscopy with arytenoidectomy is a surgical procedure where a surgeon uses a laryngoscope and an operating microscope or telescope to view the vocal cords and surrounding structures directly and remove one or both arytenoid cartilages in the voice box (larynx).

Purpose

This procedure addresses issues related to the vocal cords and larynx, such as respiratory distress or voice problems caused by arytenoid dysfunction or injury. The goal is to improve breathing and vocal function by removing obstructive or dysfunctional arytenoid cartilages.

Indications

• Severe vocal cord paralysis or dysfunction
• Bilateral vocal cord immobility
• Airway obstruction due to arytenoid cartilage issues
• Recurrent aspiration or difficulty swallowing (dysphagia)
• Voice disturbances that do not respond to non-surgical treatments

Preparation

• Patients may be required to fast for several hours before the procedure.
• Medication adjustments may be necessary, especially blood thinners or anticoagulants.
• Pre-operative diagnostic tests might include laryngoscopy, imaging studies, and a complete medical evaluation for anesthesia clearance.

Procedure Description

1. The patient is placed under general anesthesia.
2. A laryngoscope is inserted through the mouth to visualize the vocal cords and larynx using a microscope or telescope.
3. The surgeon identifies the arytenoid cartilages.
4. Using specialized instruments, the surgeon carefully removes one or both arytenoid cartilages.
5. The laryngoscope is removed, and the patient is brought out of anesthesia.

Duration

The procedure typically takes about 1 to 2 hours, depending on the complexity.

Setting

This surgery is usually performed in a hospital’s operating room or a specialized surgical center equipped with the necessary technology.

Personnel

• Head and neck surgeon or ENT specialist
• Anesthesiologist
• Surgical nurses and operating room technicians

Risks and Complications

• Bleeding or infection
• Swelling in the throat
• Hoarseness or voice changes
• Difficulty swallowing
• Reaction to anesthesia
• Rarely, injury to surrounding structures (e.g., esophagus, nerves)

Benefits

• Improved airway and breathing
• Enhanced vocal function
• Reduced risk of aspiration and choking
• Symptom relief from laryngeal obstruction

Recovery

• Patients may need to stay in the hospital for observation initially.
• Voice rest is usually recommended for several days to weeks.
• Pain management includes prescription medications and throat lozenges.
• Follow-up appointments are necessary to monitor healing and vocal function.
• Patients should avoid strenuous activities and follow diet guidelines to prevent throat irritation.

Alternatives

• Voice therapy and conservative treatments for less severe conditions
• Less invasive endoscopic procedures
• Permanent tracheostomy for severe, untreatable airway issues
• The pros and cons of alternatives often include the trade-off between less immediate relief and avoiding surgical risks.

Patient Experience

Patients might feel throat soreness and experience hoarseness immediately after the procedure. Managing pain with prescribed medication and staying hydrated will help. Most patients can resume normal activities within a few days, though voice rest and follow-up care are crucial for optimal recovery. Comfort measures such as humidity-controlled environments and gentle throat exercises may aid in healing.