When a patient has nodules, cysts, polyps, or other benign growths on their vocal cords or in other parts of their voice box or throat, we perform what is called a suspension microlaryngoscopy to remove the growths.
Take off the micro part of the term and it’s easier to understand. “Laryngo” means having to do with the larynx. “Scopy” means an action involving the use of an instrument to aid viewing. So, basically you’re talking about using a very small laryngoscope to see down into the throat to examine the larynx (the voice box) and the pharynx (the cavity connecting the nose and mouth to the esophagus). The microlaryngoscope we use at Coastal Ear, Nose, and Throat is suspended, allowing our surgeons to utilize both of their hands, rather than needing to position the microlaryngoscope with one hand and operate with the other.
Purpose of a Microlaryngoscopy
Sometimes a patient may notice his or her voice becoming hoarse or raspy. The person may feel a growth in the area. Other times, more often in children, a foreign object such as a coin or a small toy can become lodged and needs to be removed.
A microlaryngoscopy is a thorough visual examination of the pharynx and larynx. The microlaryngoscope has a fiber optic light as part the device and it can also have a laser for cutting tissue.
Lesions Removed or Addressed with Microlaryngoscopy
A microlaryngoscopy is performed for the diagnosis, biopsy, and treatment of laryngeal lesions, in addition to removing foreign objects. The lesions include the following:
- Papilloma of the vocal cords, which affects speech
- Laryngeal polyps
- Juvenile papilloma (multiple growths on the larynx, epiglottis, vocal cords, and trachea)
- Leukoplakia (a white thickening on the vocal cords that causes hoarseness)
The Suspension Microlaryngoscopy Procedure
The patient lies on his or her back on the operating table with the neck hyperextended and the head supported. This opens the throat for insertion of the microlaryngoscope. The patient is usually under general anesthesia, plus the throat is anesthetized to stop the gag reflex, in addition to blocking any pain.
The procedure involves placing the microlaryngoscope between the upper and lower teeth, over the tongue, and down into the back of the throat to allow a good view of the voice box and surrounding tissues. The microlaryngoscope is basically a hollow metal tube with a fiber optic light that shines forward. Guards are placed on both the upper and lower teeth to protect them.
In the examination, the back of the tongue, the sides of the throat, and the area behind the voice box are examined first. Then the scope is placed into the vocal box to search for abnormalities. If abnormal growths are found, they are removed either with surgical instruments or a laser.
The Suspension Microlaryngoscope
In order to give our surgeons the ability to use both hands, we use a suspension microlarygoscope. The device supports itself by attaching to a special appliance put over the patient’s chest. The microlarygoscope provides binocular vision with a 400-mm lens for excellent magnification of the areas being examined.
The patient will be prescribed pain medication to handle any discomfort. For the first seven days of recovery, the patient should talk very rarely and only at a very low level. This allows the raw tissues around the vocal box to heal. Depending on if growths were removed, absolute voice cessation may be required. The patient’s voice will be hoarse for up to two to three weeks after the procedure. Swelling will decrease over this period as the lining of the vocal cords regenerates. It is important, no matter how tempting, to avoid couching or clearing of the throat. These are basically the two most damaging things you can do during your healing.
Complications are very rare with laryngoscopy. There are the usual rare, but potential problems of infection and bleeding, or a reaction to the anesthesia. After having the growth or growths removed, most patients find that their voices return to normal in a few weeks.