Rao's ENTRao's ENT

Microlaryngoscopy (Vocal cord surgery)

What is a microlaryngoscopy?

In a microlaryngoscopy procedure, the vocal folds in the throat are observed in greater detail with magnification enabled by microscope or endoscope or video enlargement. A microlaryngoscopy is often accompanied by an additional procedure such as removal of a mass, swelling or tumour that can be done either through using delicate instruments or laser. A microlaryngoscopy can be done as an OPD procedure conducted in the physician’s office. However, most surgeons prefer to perform it in an operating room as it gives better results.

This procedure locates the underlying cause of your voice problem. If it is possible, the surgeon adds a procedure to improve the quality of your voice.

A microlaryngoscopy is an hour-long (sometimes longer) procedure that’s performed under general anaesthesia.  The surgeon first inserts a laryngoscope in the patient’s mouth moving past the teeth and the tongue of the patient to get a clear view of the larynx (voice box) and then uses a microscope or an endoscope to get a magnified view of the vocal cords.

The following procedures can be performed during a microlaryngoscopy:

  • A long (12 “approx) delicate pair of forceps is used to grasp and hold a nodule (a non-cancerous bump on a vocal cord) and then micro scissors are used to remove it. At times, the surgeon may inject fluid into the vocal fold to push a surface nodule away from the structures underneath prior to removal.
  • The laser may be used to vaporise an unwanted blood vessel or to cut out a tumour. The resulting scar tissue may be cut away with a scalpel, fat may be implanted, or the cut in the vocal fold may be left open. In some rare cases, the vocal fold may be sewn shut. A biopsy (tissue sample) may be taken for diagnosing the disease.
  • Till the preceding night of the surgery, duly take all medications prescribed to you by your ENT surgeon. Bring along any remaining medicines in original packaging when you check in for surgery the next morning. Also bring along any non-prescription medications in their original packaging that you are currently taking.
  • Get a good night’s sleep. Have a good dinner but do not eat anything at all from midnight onwards prior to the surgery day.
  • Make sure you bring your hospital file with you at the time of the check-in for surgery duly including all required test reports such as the major surgical profile, pre-anaesthetic check up sheet, radiological investigation films and reports (X-ray, CT scan, MRI, PET scan etc.) and any others investigations advised by your ENT surgeon. We advise you to ready this file a day before the surgery.
  • You should be accompanied by an attendant. We advise bringing along a close family member.
  • Please ensure that you report at the hospital at least three hours prior to your surgery’s scheduled timing.
  • Report at the reception desk in time and the hospital staff will guide you through the next steps.
  • If you have felt any changes in your physical condition such as cough, cold, fever or throat pain, be sure to mention it to your doctor and anaesthetist. If you are allergic to any drugs, be very sure to mention that as well.

First 24 hours

  • Take complete bed rest in the post-operation ward.
  • You are not allowed any drink or food till 4-5 hours after the surgery. After the surgical staff gives the go-ahead, you can sip water. A while later you can take milk or Horlicks etc. However, caffeinated beverages such as tea, coffee or aerated drinks are to be avoided as these can cause gastric irritation when consumed on an empty stomach. You can start a semi-solid diet in moderate quantities after 12 hours. You can resume normal food from second day onwards.
  • For your vocal cords to heal well, you must rest your voice completely. Do not whisper or shout as these activities strain your vocal cords. It is advised that you carry writing material (paper/pen) and communicate only through writing. Some patients may also experience numbness of tongue which usually passes in a while.

After discharge:

  • You will be discharged either on the same day or the next day of your surgery, as deemed fit by the operating surgeon.
  • Be sure to take all medications on schedule as prescribed by your surgeon. Please take the prescribed antacid half an hour before your breakfast.
  • Feeling soreness, dryness and lumpiness in throat are normal after this surgery.
  • Give complete rest to your voice for the duration (up to a week, as per the condition of the patient) specified by your surgeon. After the review visit, the surgeon will instruct you on limited voice use (e.g., 25% in 2nd week, 50% in 3rd week, 75% in 4th week).
  • You may be advised review consultations with a voice therapist who will teach you voice modulation and exercises. Apart from practicing these, you will also have to stop your voice abuse totally. Else, you will be at the risk of disease recurrence.
  • If your profession requires extensive voice usage, take a break from work for minimum 3 weeks to let your vocal cords heal.
  • You will be visiting the OPD for weekly reviews for three weeks post-surgery. Your surgeon will decide on further follow-up visits.

As with any surgical procedure, a microlaryngoscopy carries some risk. While the chances of a complication are nominal, you should understand the potential risks and clarify your concerns from your surgeon well in advance.

Here is a brief look at some possible complications:

Anaesthesia: While anaesthesia carries a slim risk of a life threatening reaction to some medication, it is a rarest of rare occurrence.

Chipped tooth: While it is uncommon, there is some risk that the laryngoscope inserted through your mouth will put pressure on the upper jaw despite your surgeon placing a plastic or rubber guard over your upper teeth.

Numb tongue: In one patient out of every five, the tongue can get pinched between the laryngoscope and the lower jaw causing the nerve (on one side or both) to get pressurized. This causes numbness of tongue that can last for a few weeks but recovers on its own.

Less-than-expected success: The results of your surgery depend on many factors besides the skill of the surgeon. These include your body’s healing ability, tendency to scar and the type of disease. Therefore, while the medical team will work to the highest ability, a few surgery outcomes may be less than satisfactory.

Bleeding: Every incision comes with a bleeding risk. Blood thinning medications and supplements (coumadin, aspirin, vitamin E, omega 3, Gingko etc) increase this risk. You should consult your surgeon and especially go over all the prescription and non-prescription medicines and supplements you are consuming. On a reassuring note, bleeding risk in a microlaryngoscopy is   nominal. The exception may be an unusual tumour made up of blood vessels (an extremely rare occurrence).

Infection: Another extremely unlikely risk in a microlaryngoscopy. Of course, every cut is a potential infection risk that can let microbes into the body but it is hardly ever witnessed in this procedure.

Breathing difficulties: Both the voice box and the windpipe are small sized. At times, a larynx infection or voice box swelling can turn severe to exert pressure on the wind pipe leading to breathing difficulties.  Your surgeon will prescribe medication to check this.

Laser complications: Another extremely rare risk in a microlaryngoscopy. Actually, the laser is a safe tool in expert surgical hands. Still some potential risks (and precautions taken by the hospital staff) are as follows:

  • A CO2 laser can injure the eye, (Precaution: safety gear covers the eyes of the patient as well as the staff.)
  • A misfiring laser can cause burns. (Precautions: Everything near the laryngoscope is covered with wet towels, wet cotton sponges are placed behind the vocal folds to catch any stray laser beams.)
  • The breathing tube can burn because of oxygen in it. (Precaution: The breathing tube is covered with fire-resistant protective metal coating.)

MAKE AN APPOINTMENT

Having any ENT issue? Don’t ignore. Get expert care…get in touch with us