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Microlaryngoscopy is a diagnostic method for examining the vocal folds and larynx. It allows you to examine parts of the respiratory tract that are difficult to access for other diagnostic methods. Microlaryngoscopy is used both independently (for diagnostic purposes) and as one of the stages of endoscopic microsurgery of the larynx (for therapeutic and diagnostic purposes). The procedure is difficult to carry out and requires special equipment, therefore it is carried out in large clinics, where there is the necessary equipment and the appropriate qualifications of doctors. As a rule, microlaryngoscopy is resorted to after other diagnostic methods have not given the expected results.
Indications for conduction
According to the famous German otorhinolaryngologist, Professor of Marburg University Oscar Kleinsasser, microlaryngoscopy is an excellent method for diagnosing malignant tumors of the larynx in the early stages.
With its help, it is possible to detect atypia of the vascular pattern, micro-ulceration of the mucous membrane, structural disorders of the epithelium of the respiratory tract and many precancerous conditions. The method allows you to simultaneously take biomaterial for histological and cytological studies.
Microlaryngoscopy is performed to determine the cause of difficulty breathing, non-closure of the vocal cords, stenosis, in patients with dubious diagnoses. Diagnostic manipulation is often combined with treatment: removal of papillomas, fibroids, leukoplakia, granulomas, polypous laryngitis, treatment of vocal cord pathologies, removal of foreign bodies.
The procedure is forbidden for people with severe heart rhythm disturbances and after a myocardial infarction, since manipulation irritates the vagus nerve and can cause severe bradycardia (slow heartbeat). The procedure is not feasible for pathologies of the cervical spine and masticatory muscles, which make it difficult to tilt the head back, open the mouth and insert the laryngoscope tube.
Preparing for the procedure
Before the procedure, the patient must be comprehensively examined. The list of mandatory studies before microlaryngoscopy includes: general and biochemical blood tests, determination of the blood group and Rh factor, coagulation indicators, examination for hepatitis B and C, syphilis, HIV, urinalysis, fluorography, indirect laryngoscopy.
Given that general anesthesia is used for microlaryngoscopy, it is necessary to examine the patient by an anesthesiologist before it to collect an anamnesis, determine anesthetic risks and select suitable drugs for anesthesia.
Method of conducting
Various laryngoscopes are used for microlaryngoscopy. A telelaryngoscope with cylindrical lenses provides good illumination of the larynx and hypopharynx, as well as obtaining an enlarged image of the examined areas. The fiber optic rhinopharyngolaryngoscope is used for disorders of the larynx. It is equipped with additional eyepieces for observation and video recording of the progress of the operation.
Microlaryngoscopy is performed under endotracheal anesthesia. This is necessary for the complete relaxation of the patient. The patient is placed on his back on the operating table. At the same time, the patient’s head is thrown back more than is necessary for the introduction of the laryngoscope, because the protectors have thick walls.
To ensure this tilting of the head, a high roller is placed under the shoulders of the patient. The head must not hang down. To protect the teeth from damage to the enamel, special protectors are inserted into the patient’s mouth.
After the introduction of the laryngoscope into the larynx, it is fixed with special devices, for example, using a special chest support mounted on the anterior wall of the chest. To examine the larynx, mucus is first sucked out of it, and then, by rotating the laryngoscope, the vestibular region, the anterior and posterior commissures of the larynx, and the vocal cords are examined. For surgical interventions, microinstruments are used (microscissors, microdissectors, microforceps.
Microlaryngoscopy procedure lasts from several minutes to an hour (if surgery is performed). After the end of the procedure and awakening the patient is placed in the ward, where he is under observation for several hours.
The price of one microlaryngoscopy depends on the volume of manipulations and ranges in Moscow from 900 to 3000 rubles and more. If surgical interventions are performed during the examination, the cost of the operation is added to the cost of the procedure.
Recovery period
After anesthesia, the muscles of the epiglottis are still relaxed and when swallowing, it does not block the glottis. Therefore, during the first two hours, the patient should not eat or drink, so that particles of food or liquid do not get into the respiratory tract. The patient is warned not to cough or gargle for several days.
The next day after microlaryngoscopic intervention, the operated areas of the larynx swell, therefore, in order not to injure edematous tissues, patients are prescribed voice rest.
Silence contributes to the rapid healing of the wound surface and the acceleration of the removal of puffiness. Its duration depends on the volume of surgery and can be observed up to a week. At this time, patients are forbidden to talk and even whisper. The voice may remain hoarse for up to 2-3 weeks.
In the postoperative period, it is strictly forbidden to smoke. Starting from the second day after the manipulation, the patient needs to drink a lot. Drinking plenty of water, especially water, contributes to an increase in the amount of sputum produced, its liquefaction and easy discharge.
Pain after manipulations on the larynx, as a rule, is minimal and does not require anesthesia. If, however, the patient complains of sore throat, he may be prescribed non-steroidal anti-inflammatory drugs (Ibuprofen, Ketorolac).
A week after microlaryngoscopy or surgery, the patient must come for a second examination to the surgeon who operated on him to control the recovery process. After the examination, the doctor gives recommendations to the patient on the further management of the postoperative period.
Complications after the procedure
Complications after microlaryngoscopy are the consequences of general anesthesia and the procedure itself. The risk of general anesthesia is associated with unforeseen reactions of the patient to the administered medications. The likelihood of allergic reactions to drugs is assessed by an anesthesiologist before manipulation. With an adequate assessment of anesthetic risks, the likelihood of dangerous allergic complications is minimal.
During the diagnostic (treatment and diagnostic) procedure itself, there is a risk of tooth enamel chipping from exposure to the metal parts of the laryngoscope.
The laryngoscope blade presses on the upper jaw and the strength of this pressure depends on several factors:
- the size of the language;
- bite characteristics;
- the possibility of tilting the head;
- mouth opening.
To avoid damage to the teeth, they are put on special protectors or a rubber tube cut along the length. In the absence of teeth in a patient, the likelihood of such a complication is excluded.
After manipulation for some time, patients note a decrease in the sensitivity of the tongue. This is due to prolonged pressure of the laryngoscope on the root of the tongue. Within a few weeks, the sensitivity is restored.
During and after the operation, as a result of microtraumatization of the tissues of the larynx, bleeding is possible. They happen rarely and usually are not strong. The risk of this complication is increased in patients taking anticoagulants and/or antiplatelet agents.
Microlaryngoscopy is considered a highly informative method for diagnosing and treating diseases of the larynx. The only drawback of the method, according to otorhinolaryngologists, is the impossibility of carrying out functional diagnostics of the larynx – the study of the mobility of the vocal cords and cricoarytenoid joints, as well as its phonatory function.