Micro Laryngoscopy

Surgical Micro Laryngoscopy

Information for patients considering a microscopic surgery on their vocal folds
  • Definition
  • Presurgery
  • Risks
  • Consent
  • Surgery
  • Recovery
  • Pain
  • Instructions during healing
The following is typical for my patients. There certainly are regional and individual surgeon variations in style.

Definition

Microlaryngoscopy is a procedure that means the vocal folds are looked at in great detail with magnification. The magnification may be with a microsc0pe, endoscope or by video enlargement. It is often accompanied by some additional procedure such as removal of a mass, swelling or tumor.

Presurgery

Before the surgery your surgeon has discussed with you in full detail the reasons for going to surgery and that you are satisfied with those reasons. You can go over any questions during this pre-surgery visit as well as again on the morning before surgery in the pre-surgery waiting area.

Risks

The main risks of the procedure are anesthesia, chipping a tooth, a sore or numb tonue, and a less-than-ex nected beneficial outcome. Other potential risks could be bleeding, infection, or breathino difficulties. If a laser is used, additional risks should be mentioned.

Anesthesia

The risk of anesthesia is that you would have a major life threatening reaction to some medication. This is very uncommon and I would compare it to getting in your car and driving some distance with the risk of an accident and dying. Even though the risk is serious. it is apparently. acceptably small. as most of us matinee to drive. In the case of surgery. you men have the added benefit of life support equipment and trained personnel standing by. St ll it is a risk for you to consider.

Chipped tooth

If you have no teeth the worst you can expect is a sore upper gum. F or others, when the laryngoscope is inserted it puts pressure on the upper jaw. Several variables enter into the amount of pressure put on your upper teeth. The bigger your tongue. the narrower your lower jaw. the greater your overbite. the tighter the {it may be and the more pressure on your upper teeth. Additionally, if you have spent your children’s inheritance on caps on your incisors. you may be at additional risk since they may be a little weaker. Large cavities or other degradation of your tooth’s strength may put you at risk for a chip. All this. even though your surgeon will likely place some type of plastic or rubber guard over your upper teeth. This is an uncommon complication. happening perhaps once a year or less in the surgeons I know.

Numb tongue

The opposing pressure to your upper teeth is the tongue. It gets pinched between the laryngoscope and the lower jaw. Often, it gets pushed more toward one side. Just like your leg going to sleep, the nerve to one or both sides of your tongue may fall asleep from the pressure on it. In my experience, this happens to perhaps 20% (a guess) of people and may last for several weeks. My experience has also been that normal sensation eventually returns to the tongue.

Less-than-expected beneficial outcome

Unfortunately, your body is not a car and we cannot go to the body shop and just put on a brand new fender. The surgeons skills, your body’s healing capabilities, tendency to scar and the type of disease present all enter into the equation of that attempted perfect result. Therefore, while everyone; surgeon. anesthesiologist, nurses and other staff strive to provide excellent care, in all likelihood perfection is tempered by the human condition. Still many results are excellent, some are good and rarely the outcome is poor. Your surgeon will likely temper your expectations based on the type of disease being treated as that has a major effect on the expected outcome.

Bleeding

This has not been a significant risk in my experience. Anytime a cut is made; there is the risk of bleeding. If you are on any medication that may thin the blood, that can increase the risk. Examples of medications that might prolong bleeding include Coumadin, aspirin or even vitamin B. You should go over all medications that you take with your physician before surgery. Even given these risks, the cuts in microlaryngoscopy are typically exceedingly small and though under the microscope, it may look like a lot, it is typically miniscule. The exception might be in the case where you have some unusual tumor made up of blood vessels.

Infection

This almost seems like a theoretical risk, it has been so uncommon in my experience. Certainly, any time a cut is made, that becomes a route for bacteria to potentially enter into the body. For some reason this is extremely rare in laryngoscopy. Perhaps because the cuts are small, perhaps because the upper airway has a very good defense system. Still, it is possible.

Breathing difficulties

This has been much less common in my experience than it would seem to be based on logic. The voice box and windpipe are of a limited size and even the somewhat common infection of laryngitis can occasionally turn severe enough to make breathing difficult. There is almost always some swelling after working on the voice box. Your surgeon will usually be able to predict the risk based on how much is being done. Medications, particularly steroids, can help decrease swelling if it occurs.

 

Consent

I will ask you to sign an informed consent form before going to surgery.

Surgery

Anesthesia

When microlaryngoscopy is performed in the operating room, it is usually done with the patient asleep. You may hear by phone from your anesthesiologist the night before or you may meet him/her the morning of surgery. You should tell them of any problems you have had in the past or any concerns you have about having anesthesia. In particular, if you have had trouble with nausea or vomiting in the past. your anesthesiologist may be able to adjust your medications to decrease the chance of stomach acid irritating your vocal folds as it comes back up.

Procedure

The operating room table is often pre-chilled (I warned you). You will be put to sleep with medicine through a vein and may have a mask on to breathe some oxygen while falling asleep. After you are asleep, your head is tipped quite far back. The surgeon sits at the head of the table, essentially above your head. An instrument called a laryngoscope is inserted through your mouth so the surgeon can see down your throat past the back of your mouth. The laryngoscope is a hollow metal tube that when placed in the proper position allows a direct View of your voice box. It pushes the teeth and the tongue out of the way. To protect your teeth from chipping, a rubber or plastic tooth guard is placed over your upper teeth. Your neck is extended so that the surgeon has a view straight down your throat from above. It is a bit like sword swallowing. Your eyes are closed and padded for protection. The surgery is delicate and a bit tedious but not difficult. It may take about an hour to perform a typical surgery, though this varies a lot. Many types of procedures can be performed during a microlaryngoscopy. Some typical procedures would include using long (about 12 inches) delicate forceps to’ grasp and hold a nodule Then microscissors are used to remove the bump. Sometimes fluid is injected into the vocal fold to push a surface bump away from the underlying structures before it is cut. A biopsy or small sample may be taken to find out what disease is present. I cannot personally think of an occasion to strip a vocal fold. Use caution, if you hear that term. That procedure can cause more harm than good.

Recovery

You wake up rather quickly and find yourself still in the operating room or in the recovery room. You stay in the recovery room until the nurses and anesthesiologist are certain the majority of the anesthetic is gone from your system. You then return to the day surgery area where you started. When you can stand steadily, keep liquids down without nausea or vomiting and can go to the bathroom (essential human activities) you may go home. The whole process takes up a good part of the day.

Pain

Typically there is minimal pain after surgery, Since this varies from person to person and procedure to procedure.

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