Surgery of the Pharynx and Larynx

Surgery of the pharynx and larynx is a separate area of otolaryngology aimed at the surgical treatment of diseases and pathological conditions of the pharynx and larynx. In modern otolaryngological practice laryngeal pathologies are often detected. They are mainly attributed to either the professional use of the voice or bad habits (smoking, drinking alcohol), but a special feature of these problems is that they progress for a long time latently, that is, without obvious symptoms, with the exception of slight hoarseness. This considerably delays timely diagnosis and affects the success of treatment.

Because of the peculiar anatomical position, it is impossible to see pathologies of the larynx during a normal ENT examination without special endoscopic equipment. That is why diseases of the throat and larynx are very often detected at the stage when they do not respond to conservative therapy any longer. In the process of evolution, the pharynx was formed as a single organ which became the beginning of the respiratory and digestive tracts, due to which vital functions such as normal breathing and respiratory protection, nutrition and phonation are performed. Thus, if one of the parts of the pharynx or larynx is damaged, there is a gradual disturbance of two functions at once, both digestive and respiratory.

Diseases of the pharynx are the most common ENT pathologies. Most throat diseases are successfully treated with conservative methods such as drugs and physiotherapy. But there are pathologies (tumours of the throat and larynx, polyps of the vocal cords, recurrent acute tonsillitis, vallecular cysts, etc.) in which surgical intervention is the only effective treatment.

The indications for endolaryngeal surgery are recurrent inflammatory processes and various dysfunctions of the oropharynx and larynx:

• Hoarseness that lasts more than 3 weeks;
• recurrent acute tonsillitis, laryngitis, pharyngitis;
• snoring and sleep apnea;
• foreign body sensation or a “lump” in the throat;
• voice disorders ‒ hoarseness, aphonia (loss of the voice), change in the timbre;
• difficulties in breathing and eating;
• enlarged tonsils and submandibular lymph nodes;
• throat injuries.

If you experience difficulties in swallowing and breathing, the timbre of the voice has changed, streptococcal pharyngitis occurs several times a year, you should book an appointment with an otolaryngologist surgeon.

The doctor will make an examination, prescribe a number of necessary tests and propose the most optimal treatment plan. It often happens that the only effective way to get rid of the disease is surgery. You shouldn’t be afraid of this ‒ thanks to a simple operation, after a few days you will feel much better ‒ all annoying and uncomfortable sensations will disappear, and throat inflammations will no longer annoy you.

Surgery to Remove Neoplasms of the Throat and Larynx

Surgery to remove neoplasms in the throat and larynx is a minimally invasive endolaryngeal operation which is performed to treat diseases characterized by the emergence and growth of various tumour-like masses on the mucous membrane of the throat and larynx, as well as on the vocal cords. The emergence of neoplasms is accompanied by a feeling of discomfort in the throat and voice disorders. Larger neoplasms can become a cause of respiratory impairment.

German specialists have perfect mastery of the microsurgical neoplasm removal technique. With the help of modern support equipment, a minimally invasive intervention is performed under a microscope, which makes it possible to quickly eliminate vocal nodules, polyps and other pathological tissues. As the procedure is low-traumatic, the patient can leave the hospital 1-2 days after surgical treatment.

Neoplasms in the throat and larynx cause discomfort to the patient as a result of the direct effect on the person’s speech and breathing. Most often, patients seek help because of voice disorders or a complete loss of the voice, difficulties in breathing. In severe cases, laryngeal obstruction may occur when the laryngeal lumen becomes obstructed with a neoplasm. In such cases, surgical treatment is required to remove excess tissue inside the respiratory tract.

Diseases that are indications for surgery:

• Polyp of the vocal cords or larynx;
• papilloma of the larynx;
• fibroma of the larynx;
• air-filled cyst of the vocal cord (laryngocele) or larynx;
• pachydermia;
• “singer’s” nodules;
• Reinke’s edema;
• contact granuloma of the vocal cords;
• vocal cord cancer;
• capillary ectasia of the vocal cords in singers.

Surgical removal of neoplasms of the throat and larynx is performed with microsurgical equipment. The operation involves the use of endotracheal aesthesia with adaptive lung ventilation (ALV). The duration of the procedure, depending on the size of the neoplasms and their localization, can vary from 30 to 120 minutes.

Endolaryngeal removal of polyps, nodules or tumours involves placing special supporting equipment inside the larynx under the control of a MOVENA S7 microscope (Germany). Through it by using microsurgical instruments, the larynx neoplasm is exposed. Then by means of a holmium laser beam the tumour bed and the tumour mass itself are evaporated. The mucous membrane is preserved and glued together, which contributes to faster recovery. After that the surgeon injects anti-inflammatory drugs into the larynx, preventing the development of complications and accelerating the regeneration of the damaged tissues.

After removal of vocal cord tumours, normal air passage through the airways is restored, symptoms regress and the voice is gradually recovered.

Microsurgical Removal of Laryngeal Cysts

Laryngeal cyst removal is a microsurgical operation, during which by means of special micro instruments the entire contents of the cyst is removed along with the capsule through the incision in the laryngeal mucosa. The procedure is performed under a microscope.

When laryngeal cysts increase in size, they can cause breathing and voice disorders and a sharp narrowing of the laryngeal lumen. In this case, the cyst must be removed. A timely performed operation will help prevent serious complications such as a complete breathing disorder and loss of the voice.

The following conditions are indications for the removal of laryngeal cysts:

• Hoarseness over a long period of time;
• difficulties in breathing;
• a sharp narrowing (stenosis) of the laryngeal lumen;
• regular difficulties with food intake, when its debris fall into the windpipe or nasal cavity, and the person has a fit of coughing.

As a rule, the modern endolaryngeal technique is used to remove a laryngeal cyst. The surgeon uses microsurgical instruments under the control of an operating microscope. Manipulations are carried out by using the latest modern laser and radio wave equipment produced in Europe and the USA. Thanks to this approach, point surgery is performed, aimed specifically at the focus of the pathology with minimal trauma to the adjacent tissues.

The operation is performed under general endotracheal anaesthesia. At the first stage, special supporting equipment, a laryngoscope, is placed into the larynx under a microscope. Then, through it, the surgeon makes an incision in the mucous tissue of the larynx and exposes the cyst with the capsule. After that, the cyst, together with its contents, is completely removed, the edges of the mucous membrane are matched, glued together, and the area is treated with anti-inflammatory drugs.

The operation takes no more than half an hour.

Laryngeal cysts are not removed only in conditions that threaten the patient’s life, such as acute myocardial infarction, stroke, cancer, blood diseases, and decompensated diabetes mellitus. In all other cases and in the presence of indications for cyst resection, the operation to remove it is the only and effective way of getting rid of this pathology.

Surgery to Remove Laryngeal Fibroma

The operation to remove laryngeal fibroma is a complex microsurgical technique, the purpose of which is to remove a fibrous tumour on the muscles of the vocal cords. The tumour usually grows slowly and has a benign nature. Yet, it becomes difficult and sometimes impossible for a person to talk, breathing is disturbed, there is a feeling that a foreign object is stuck in the throat. Surgery is the only way to treat this pathology.

Doctors recognize the reasonability of surgical intervention for long-term disorders of the vocal apparatus (hoarseness, loss of the voice), impaired breathing and the threat of complete closure of the laryngeal lumen. Each case is considered by otolaryngologists individually. They take into consideration the existing symptoms and general health. If according to the results of such an examination the patient is offered an operation, it means that this option is indeed optimal, and in many cases vital, therefore the delay in its implementation is highly undesirable.

The surgical intervention is performed under general endotracheal anaesthesia.

Supporting microsurgical equipment provided with a high-precision microscope is used to perform the operation. Under a strong optical magnification the surgeon dissects the mucous membrane of the larynx at the site of neoplasm localization, then exposes the tumour and excises it using a laser, while simultaneously cauterizing the affected blood vessels. Due to this, considerable blood loss is eliminated and postoperative risks are minimized. Having removed the fibroma, the surgeon pulls the edges of the mucous membrane of the vocal cords together.

The operation lasts about 90 minutes, and if the neoplasm is benign, the prognosis is favourable.

Surgery to Remove Laryngeal Papillomas

Surgical treatment for laryngeal and tracheal papillomatosis is a surgical technique for removing outgrowths of papillomas in the laryngopharynx in case of their threatening development. The proliferation of papillomas on the mucous membrane of the vocal cords and in other parts of the respiratory system is fraught with not only the loss of the voice, but also the risk of impaired respiratory function, up to complete airflow obstruction, as well as malignant transformation of the process.

Surgical intervention for endolaryngeal removal of a papillomatous mass is performed under general endotracheal anaesthesia under the supervision of an experienced anaesthesiologist. German doctors use supporting equipment under a high-precision microscope as well as modern microsurgical instruments. To remove the pathological outgrowth, the doctor uses laser coagulation technique which is one of the most painless and safe. The defocused laser beam is directed at the papilloma, causing the destruction of the pathologically changed overgrown tissues and gradual evaporation of the outgrowth. Cauterization is performed layer-by-layer with simultaneous sealing of blood vessels, which minimizes surgical blood loss. Adjacent tissue injury and the risk of inflammatory complications are also minimized.

The operation lasts, depending on the complexity of the case, from half an hour to 90 minutes.

The operation makes it possible to fully open the laryngeal lumen, to eliminate the impact on the vocal cords and other negative symptoms. Except rare cases, a single surgical intervention is enough to cure.

Microsurgical Removal of Laryngocele

Microsurgical removal of laryngocele is a minimally invasive surgical intervention that makes it possible to eliminate air-filled cysts in the larynx area. The problem considerably disturbs the way the patient feels and requires a radical solution. By performing a technically simple operation, it is possible to forget about the annoying disease forever.

The operation to remove an air-filled cyst in the laryngeal area is carried out after a full examination of the patient. The indications for this surgery are:

• Obstruction of the laryngeal lumen;
• lingering hoarseness;
• respiratory impairment;
• difficulty in swallowing;
• choking while talking.

Microsurgical removal of laryngocele is performed under general anaesthesia. The total duration of the procedure is 1.5-2 hours on average.

Microsurgical removal of laryngocele is an operation that can be compared with the work of a jeweller. Special supporting equipment is placed in the larynx under a microscope. Through it, by using microsurgical instruments, an incision is made in the laryngeal mucosa, the air-filled cyst with the capsule is exposed and then removed. The edges of the mucous membrane of the vocal cords are matched. Anti-inflammatory drugs are used to treat the area that has been operated on. Mixed laryngocele is removed via an external approach, combined with the internal endolaryngeal one.

Surgery to Remove “Singer’s” Nodules

Surgery to remove vocal cord nodules is a microsurgical procedure during which neoplasms of the vocal cords are removed under the control of a microscope. Such neoplasms are typical mainly for people who subject their vocal cords to overload due to their occupation (vocalists, educators, teachers, lecturers, lawyers, guides, forwarding agents).

“Singer’s” nodules is a pretumor disease in the form of growths of tubercles on the mucous membrane of the vocal cords. At first they are soft, but over time they can become hard and acquire a fibrous character. In this case, the patient complains of rapid fatigue, hoarseness, which, as the nodules grow, becomes more pronounced and persistent. In such cases conservative treatment has no effect, and surgical intervention is necessary in order to preserve the voice.

The operation is performed in a hospital under general endotracheal anaesthesia.

We use modern techniques in phonomicrosurgery ‒ endolaryngeal removal of vocal cord nodules in the supporting equipment under the control of a microscope. Manipulations are carried out using the latest specialized equipment which provides a point low-impact exposure on the focus of the pathology.

At the first stage the surgeon installs a special instrument, a laryngoscope, to provide access to the vocal cords. Then, by means of microsurgical instruments, laser and radio wave technology, the neoplasms of the vocal cords are evaporated.

We do not perform the removal of vocal cord nodules in patients with myocardial infarction, cerebral vascular insult, coma and decompensated diabetes. In the absence of these conditions, timely surgery will help avoid complications, preserve and recover the voice.

The result of the operation is the recovery of the patient’s voice capabilities due to the clearance of the vocal cords from pathological growths.

Vocal Cord Surgery

Operations on the vocal cords are microsurgical interventions that are carried out in patients with pathological changes in the tissues of the vocal cords or vocal fold motion disorders. If such conditions last long, they can lead to persistent hoarseness or complete loss of the voice.

If conservative treatment does not help recover the voice, the only way to do this is surgical correction.

Operations on the vocal cords are performed in patients whose speech functions are impaired because of pathological processes in the larynx. This is manifested by a decrease in the strength of the voice and its hoarseness.

Such symptoms are typical for:

• Neoplasms of the vocal cords;
• mucous membrane pemphigoid of the larynx;
• paresis and paralysis of the larynx.

In these cases only the operation will help get rid of the pathology and restore the voice function.

Depending on the clinical picture and the course of the operation, the procedure lasts from 10 to 140 minutes.

At the first stage, under the control of a microscope the surgeon places a special support with an endoscopic instrument, a laryngoscope, in the larynx in order to gain access to the vocal cords. Further tactics of the operation depends on the chosen technique.

Cordotomy and Arytenoidectomy

When performing these techniques, the surgeon uses microsurgical instruments and a laser to evaporate the immobile structures of the larynx ‒ folds, muscles, cartilage areas. Thus, the immobile part of the vocal cord and the cartilage to which it is attached is excised. The laryngeal lumen dilates, and the patient can fully breathe naturally. At the same time, in order to preserve the voice function, the doctor removes the vocal fold so that the vocal processes will contact.

Cordopexy

With this technique the vocal fold is preserved, but it is shifted and stitched to the lateral wall of the larynx. This also makes it possible for the person to breathe through natural airways. Due to the sparing preservation of areas of the vocal cords, not only breathing is restored, but also the voice is preserved.

The specific technique is chosen individually for each patient depending on the clinical picture of the disease. Operations on the vocal cords are contraindicated only in severe health conditions: myocardial infarction, cerebral stroke and coma. In other cases, in order to preserve the voice, the operation should not be postponed.

Laryngoplasty

Laryngeal plasty is a microsurgical operation that is performed in case of cicatricial stenosis of the larynx, when its lumen is narrowed, which causes a failure of the respiratory function.

In the chronic form of the pathology, when medical therapy is no longer effective, only surgery can restore normal physiological breathing. During it, cicatrices are excised and the laryngeal lumen is restored to the required diameter.

Laryngoplasty is indicated for the following conditions:

• Chronic laryngeal stenosis;
• cicatricial pemphigoid of the larynx;
• scars after removal of papillomas and neoplasms of the vocal cords;
• scars in the larynx after burns and injuries.

Before the operation, the patient is subjected to general anaesthesia with the endotracheal intubation.

After that, under a microscope, the doctor places in the larynx a special support, a laryngoscope, through which by means of a laser or radio-wave scalpel, the scar membrane is evaporated and the scars between the vocal cords are excised. To consolidate the effect, the manipulation is supplemented with balloon plasty. A catheter with a balloon is inserted into the area of the laryngeal constriction, filled with water and slowly inflated. The balloon is left for some time, during which it presses against the walls of the larynx, expanding the airway lumen to the required size.

Laryngoplasty is performed in steps. There are 2-3 stages with an interval of 3-6 months. This approach enables to get a lasting result in the restoration of the voice and respiration and to avoid pronounced swelling of the laryngeal mucous membrane in the early postoperative period.

Depending on the situation, the operation can last from 10 to 140 minutes.

Laryngoplasty is not performed only in critical conditions, such as myocardial infarction, cerebral stroke and coma. In other cases, if indicated, surgical intervention is a necessary measure to restore respiratory function.

Treatment for Laryngeal Edema (Reinke’s Edema)

Microsurgical treatment for polypous laryngitis is a modern, high-technology and safe way to eliminate indurations of the larynx mucosa with the subsequent elimination of annoying symptoms.

Reinke’s edema is a disease characterized by gradual development. In the early stages the disease can be slowed down medicamentally. However, over time, the pathology progresses and for its effective treatment surgical intervention is required.

The indications for surgical removal of Reinke’s edema are:

• Voice disorders;
• respiratory failure;
• stenosis of the larynx.

Ignoring the symptoms is fraught with the development of respiratory and heart failure with an increase in right ventricular size. The reasons for the development of Reinke’s edema are the negative effects of tar, nicotine, formaldehyde during smoking, excessive load on the voice (singers, teachers), and thyroid disease. These factors provoke respiratory failure and hoarseness.

Microsurgical removal of Reinke’s edema is performed through the use of a modern, powerful surgical microscope. Due to magnification of many times, the doctor can detect pathological areas that are invisible under normal circumstances. The surgeons perform the evaporation of the changed tissues using a holmium laser. The duration of the procedure depends on the mucosal extension of pathological zones and can vary from 20 to 120 minutes.

After the patient receives anaesthesia, the doctor places a special supporting laryngoscope. Then microsurgical instruments are inserted into the laryngeal cavity as well as the laser, with which the surgeon removes the changed tissue.

Microsurgical treatment for polypous laryngitis ensures complete removal of the indurations from the mucous membrane of the larynx. As a result, the annoying symptoms are eliminated, the voice is improved, and the patient’s well-being comes to normal. The patient can notice a marked improvement almost immediately after the intervention. However, the full effect of treatment is felt closer to the end of the 2nd week after surgery.

Elimination of Paresis and Paralysis of the Larynx

Surgery to eliminate paresis and paralysis of the larynx is a type of surgical intervention that makes it possible for the patient suffering from dysfunction of the laryngeal muscles to fully or partially recover the voice and breathing. These structures are responsible for the tension of the vocal cords. The operation eliminates the clinical symptoms that bring discomfort to the patient and affect his or her quality of life.

Reduced mobility or complete paralysis of the larynx is a serious pathology that requires surgical treatment. It is often accompanied by the formation of a cicatricial membrane. This is the main indication for surgical treatment.

The cause of the development of the pathological condition may be a number of other diseases (laryngitis, tracheitis, trauma, tumours of the mediastinum or esophagus, etc.). In our clinic, in addition to the surgical correction of the disease, we also choose an adequate supportive treatment for laryngeal paresis, which is aimed at improving the way the patient feels.

Paresis/ paralysis of the larynx and the formation of the cicatricial membrane are accompanied by the following symptoms:

• Weakness and hoarseness;
• loss of ability to talk (aphonia);
• constant coughing;
• respiratory function disorder up to asphyxia.

Cordotomy or Arytenoidectomy

Under the control of an ENT microscope, special supporting equipment is placed in the larynx. The immobile structures of the larynx ‒ folds, muscles and cartilage areas ‒ are evaporated through it by means of microsurgical instruments and a laser. The procedure removes the immobile part of the vocal cord and the cartilage to which it is attached. Due to this, the laryngeal lumen becomes wider, and the person can breathe through natural airways. In addition, the vocal fold is removed so that the contact of the voice processes can be maintained. This makes it possible to save what remains of the voice.

Cordopexy

During the operation, the vocal fold is preserved, but it is stitched to the lateral wall of the larynx. This makes it possible to expand the laryngeal lumen, and for the person to breathe through the natural airways. The voice can be restored if you train the opposite side of the larynx.

Tracheoplasty

Tracheal plasty is an intervention aimed at restoring the anatomical structure and the full function of the respective organ. The operation can be carried out if there is a possibility of reconstruction of the natural respiratory tract with subsequent removal of the tracheostomy tube.

The indications for surgical treatment are:

• Prolonged usage of a tracheostomy tube (with the exception of patients with laryngeal cancer);
• chronic cicatricial tracheal stenosis;
• cicatricial membrane of the larynx, trachea;
• fusion of tracheal rings (tracheomalacia);
• fistula on the neck after removal of the tracheostomy tube;
• effects of injuries and burns to the respiratory tract.

Tracheal plasty is usually performed in three stages. This ensures the achievement of the desired result with minimal health risk. The intervention is performed under general anaesthesia with artificial ventilation of the patient’s lungs.

The first stage of the operation involves the evaporation of scar tissue by means of microsurgical instruments and a laser beam. To do this, the surgeon, under the control of a microscope, places inside the larynx special supporting equipment, through which the necessary instruments are inserted. At the second stage, the surgeon inflates the created channel with a balloon. This consolidates the effect. The final stage is the closure of the defect on the neck with a cartilaginous alloplant or a silicone implant.