What is a Direct Laryngoscopy with or without biopsy?
The larynx is the medical term used for the voice box. The voice box contains numerous structures including the vocal cords, which are the muscles and membranes that vibrate to produce sound. This sound is then shaped and altered by the remaining structures of our throat and nose, to give each of us a unique voice. Laryngoscopy is the name of the surgical procedure in which your surgeon will closely inspect the larynx and tissue around the larynx. A biopsy or remove abnormal tissue may be performed. Some laryngoscopies are performed for diagnostic purposes only—example there is an abnormal area on the vocal cord that needs to be biopsied to determine what it is. Some laryngoscopies are therapeutic meaning the lesion can be completely removed to treat the underlying problem. Your surgeon will discuss prior to surgery whether your procedure is anticipated to be diagnostic or therapeutic.
What to do BEFORE surgery
Here are a few things you can do before surgery to help things go more smoothly:
- Eliminate ALL medications that thin your blood for two (2) weeks before surgery, unless directed otherwise by your surgeon. Please see this list--Medications to Avoid Prior to Surgery
- Stop smoking at least 3 weeks before your surgery date.
- If you gets a cold or fever during the 5 days before the surgery, please notify us. A cold may increase the risk from anesthesia.
- Sometimes blood counts and clotting is checked before surgery to make sure you are not at risk of increased bleeding. Labs need to be drawn the week prior to surgery. Your insurance carrier may dictate the lab where the blood is drawn.
- No food 8 hours prior to surgery. No liquids for 4 hours prior to surgery.
- Arrange for a ride home after the procedure
What to Expect During Surgery
This surgery is performed under general anesthesia, so that you don’t feel discomfort, cough, gag, or have problems breathing during the procedure, which allows for much more precision during the inspection and tissue removal. You will be asleep for the entire surgery. Surgery typically lasts 20-30 minutes, and is done as an outpatient, meaning you can go home a few hours after the surgery is completed.
What to expect AFTER surgery
- A sore throat is normal surgery. This is a result of having a breathing tube down your throat as well as the instruments to inspect your throat and any biopsies taken. Usually sore throat resolves in 7-10 days.
- Some hoarseness is not unexpected. This is the result of mild swelling present from the breathing tube and any biopsies taken.
- Limit voice use until cleared by your surgeon. This means using your voice no more than 20 minutes per hour. Refrain from yelling, whispering, or talking on the phone.
- Most patients have very little pain and can manage any discomfort with over the counter preparations such as Tylenol. Prior to taking any NSAIDs (example Ibuprofen) please clear this with your surgeon.
- Most patients can return to work/school the following day.
- Avoid any strenuous activity, exercise, lifting more than 10 pounds, excessive bending or straining for 1-2 weeks following surgery to prevent bleeding.
- Drink plenty of fluids. There are no dietary restrictions.
- Heartburn and acid reflux can impair healing. We typically recommend all patients, even those with no history of reflux, take acid reducing medications such as Nexium during the healing process.
- If you have any significant shortness of breath or difficulty breathing call 911.
What are the risks of Surgery?
As with any surgical procedure, direct laryngoscopy has associated risks. Although the chance of a complication occurring is small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have.
BLEEDING – It is not uncommon to cough or spit out streaks or a few small clots of blood after laryngoscopy. Let us know if there is persistent or heavy bleeding.
HOARSENESS –After surgery your voice might be more hoarse. This is often temporary and due to intubation (having a breathing tube placed), swelling or irritation at biopsy site. Permanent hoarseness after surgery is very uncommon but can occur due to scarring. Poor scarring of the vocal folds can cause loss of the normal rhythmic vibrations of your vocal folds, or a web like scar may develop at the front of your larynx.
SWELLING– If too much swelling occurs in the region of the larynx, this might cause difficulty breathing. Although this is very rare, if you experience shortness of breath, or difficulty with inhaling or exhaling air call 911.
NEED FOR FURTHER TREATMENT/FAILURE TO IMPROVE – Depending on your particular condition, sometimes the problem can recur. Sometimes we identify a condition that needs more treatment. Depending on your condition, the recommended treatments may vary widely.
DAMAGE TO TEETH/GUMS/LIPS – On rare occasion, despite the use of tooth protectors during the surgery, one of more of your teeth might get chipped, cracked, knocked lose, loss of crown, or the gums or lips could be cut. We take the utmost care to protect all of these structures.
NUMBNESS OF YOUR TONGUE / LIPS – While rare this is most often temporary. This may result from the instrument we use to inspect the throat pressing against the side or top or your tongue or lips. This can occur despite the gentlest approach during the procedure.
WEAKNESS OF YOUR TONGUE – Like numbness, pressure of the laryngoscope against the side of your tongue could rarely cause a temporary weakness of the tongue. This is extremely rare.
ANESTHESIA RISKS--As with any type of surgery, the risks of anesthesia such as drug reaction, breathing difficulties and even death are possible. Please discuss these risks with your anesthesiologist. Fortunately, with this procedure, anesthetic problems are exceedingly rare.