Microlaryngoscopy (ML)

 

Indications

  • Examination, with or without biopsy, of the larynx.  This is the first-line diagnostic procedure for vocal cord lesions, including suspected cancer.
  • Concurrent excision of benign/small malignant tumours.
  • Concurrent phonosurgery – surgery to improve the quality of the voice
  • Concurrent treatment of other airway disorders e.g. laryngeal web, subglottic stenosis.

 

Procedure

The patient may be ventilated via a slim endotracheal tube (an “ML tube”), or using supraglottic or subglottic jet ventilation.  The latter techniques provide better visualisation.

The patient is positioned supine, with the head extended on the neck, and neck slightly flexed ("sniffing the morning air").  A mouth guard or wet swab is used to protect the upper teeth.  A laryngoscope (often Dedo-Pilling, but others are used) is advanced carefully to provide a view of the vocal cords. The scope is then usually suspended so that the surgeon can use both hands.  A microscope and/or Hopkins' endoscope is used to examine the larynx and undertake the procedure, which may include steel instruments or laser.

 

Length of procedure

Variable depending on the procedure planned.  A straightforward diagnostic ML may take only 15 minutes.

 

Complications

Variable depending on the procedure carried out.  The complication below are for a straightforward ML + biopsy of a vocal cord lesion.

Pain  Patients are likely to have a slightly sore throat.

Bleeding  Usually very minor, unless the pharynx is injured unintentionally.

Dental/lip/jaw trauma  Ask patients about their dentition and document carefully.

Need for further treatment Dependent on histology.

Voice rest  If anything is done to the vocal cords, patients are often asked to rest their voice completely for around 48 hours, followed by relative voice rest.  Check the operation note.

 

Post-operative management

A patient will usually go home the same day and be followed up in clinic in approximately 2 weeks for histology results.

 

TTO

Simple analgesia is usually sufficient.  Some surgeons may prescribe a PPI.

 

 

 

 Page last reviewed: 21 September 2017