Microlaryngoscopy is a diagnostic and therapeutic procedure in which the larynx is visualized through a microscope. It provides a magnified view of the larynx and is much better than direct or indirect laryngoscopy. The procedure, normally performed under general anaesthesia, requires placing a short metal tube called laryngoscope into the larynx through the mouth and making observations through the microscope attached to the instrument. Diagnostically, the procedure is performed
to visualize the larynx for conditions like of hoarseness of voice , for biopsy of laryngeal lesions or for assessing the extent of trauma to the larynx. Therapeutically, the procedure may be performed for removing foreign bodies, for administering Teflon paste into vocal cord, for laser cordectomy to treat carcinoma of vocal cord, for placing stent into the larynx and for the excision of vocal nodules and cysts.
How the surgery is performed
The procedure roughly takes 30 minutes and generally does not require hospital stay. The patient is given general anaesthesia and is placed in the Boyce position with flexion of cervical spine and extension of the atlanto-occiptal joint. The surgeon holds the laryngoscope in the right hand, inserts it into the oral cavity until the epiglottis is located. Lifting the tip of the epiglottis with the laryngoscope, the surgeon visualises the larynx and fixes the scope to the chest piece. If required, surgery on the voice box can be performed through the laryngoscope using minimally invasive technique. If cancer is suspected, biopsy is done. Laser treatment may be the best option for certain types of lesion. Microlaryngoscopy provides magnified binocular vision and also offers exact precision. The surgeon finds it convenient because he can use both the hands. A video is attached to the microscope that allows documentation.
Complete voice rest is required for 7 days after surgery. Pain killers may be prescribed by the surgeon and throat discomfort is quite common. Coughing should be avoided for 2 weeks. Antibiotics as prescribed by the surgeon, has to be taken. Liquid intake is highly recommended but hot and acidic things should be avoided. Speech therapy may be required to restore functioning of the vocal cord. Voice may be hoarse for the first week after voice rest but would gradually improve.
Authored by Dr Shailesh Pandey, ENT Specialist
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