Name of the Procedure:

Laryngoplasty for laryngeal web with indwelling keel or stent insertion.

Summary

Laryngoplasty is a surgical procedure to treat a laryngeal web, which is a thin layer of tissue obstructing the voice box (larynx). The surgery involves placing a keel or stent to keep the airway open as it heals.

Purpose

This procedure aims to restore normal breathing and voice function by removing the obstructive tissue. The insertion of the keel or stent prevents the web from reforming during the healing process.

Indications

• Difficulty breathing
• Hoarseness or changes in voice
• Stridor (a high-pitched wheezing sound)
• History of repeated laryngeal web formation

Preparation

• Fasting for at least 8 hours prior to surgery
• Adjusting or temporarily discontinuing certain medications (as advised by the surgeon)
• Preoperative diagnostic tests, such as laryngoscopy or imaging studies, to assess the extent of the web

Procedure Description

1. The patient is placed under general anesthesia.
2. An endoscope is inserted through the mouth to provide a clear view of the larynx.
3. Surgical instruments are used to carefully excise the web.
4. A keel (a small, thin plate) or stent is inserted and secured to prevent the web from re-forming during the healing process.
5. The keel or stent is left in place for several weeks and then removed in a follow-up procedure.

Duration

The procedure typically takes 1 to 2 hours.

Setting

This procedure is performed in a hospital or specialized surgical center.

Personnel

• Otolaryngologist (ENT specialist) or laryngeal surgeon
• Anesthesiologist
• Surgical nurses and operating room technicians

Risks and Complications

• Infection
• Bleeding
• Reaction to anesthesia
• Scar formation or restenosis of the larynx
• Hoarseness or changes in the voice
• Temporary discomfort from the keel or stent

Benefits

• Improved breathing
• Restoration of normal voice function
• Prevention of web recurrence
• Benefits are typically realized a few weeks to months post-surgery.

Recovery

• Limited speaking and voice rest following the procedure
• Follow-up appointments for stent or keel removal
• Gradual return to normal activities over 2 to 4 weeks
• Adherence to specific postoperative care instructions to facilitate healing

Alternatives

• Endoscopic dilation: a non-surgical option that involves stretching the web tissue
• Laser excision: less invasive but may have a higher recurrence rate
• Each alternative has its own set of pros and cons, which should be discussed with the physician.

Patient Experience

• The procedure is performed under general anesthesia, so no pain is felt during surgery.
• Postoperative discomfort can be managed with prescribed pain medications.
• Patients might experience temporary difficulty swallowing or talking, which usually resolves with healing.