Pediatric Vocal Cord Surgery (including CO2 laser)
What is VOCAL CORD surgery?
Vocal cord surgery is a general name for many different types of procedures that can be performed on the vocal cords.
What are the indications for vocal cord surgery?
Vocal Cord surgery is performed when the vocal cords have growths, such as, polyps, tumors, or other masses that need to be removed for biopsy or to improve function. The child will usually exhibit a hoarse or raspy voice.
Vocal Cord surgery is also indicated to normalize vocal cord functioning when the vocal cords are scarred from various causes, paralyzed, or are otherwise abnormal. These conditions may interfere with the complete opening and/or closing of the vocal cords, which is necessary for normal speech and breathing.
How is vocal cord surgery performed?
Surgery on the vocal cords can be performed either directly in an open surgical approach (making an incision in the neck) or indirectly through an endoscopic approach (through a tube inserted into the mouth and throat).
Either procedure is performed under general anesthesia (the patient is fully asleep).
An open surgical approach is most often performed after trauma or fracture of the larynx (upper front of neck) has occurred. Please see REPAIR OF FACIAL AND NECK TRAUMATIC INJURIES in “Surgeries We Perform”.
Although the open surgical approach allows somewhat better control of the vocal cords during the procedure, the endoscopic approach may be more successful in restoring more normal voice sound. The endoscopic approach also has the advantage of allowing extremely close observation of the vocal cords, therefore resulting in a precise and accurate cut or removal of tissue. However, not all surgeries can be performed endoscopically. Be sure to discuss this option with your doctor.
Recovery after either an open or endoscopic approach includes minimizing damage to the larynx during surgery, as well as reducing inflammation after the surgery. Therefore, your Pediatric ENT surgeon will recommend the procedure he/she feels will minimize these complications.
What is involved with endoscopic vocal cord surgery?
Endoscopic vocal cord surgery is basically MICROLARYNGOSCOPY (magnified examination of the vocal cords) in addition to a corrective procedure performed on the vocal cords.
As mentioned above, this surgery is performed with the patient under general anesthesia (fully asleep). The patient is lying on the back and a laryngoscope is inserted in the mouth to hold down the tongue and visualize the vocal cords. A special telescope or operating microscope is used to get very close and detailed views of the vocal cords and surrounding areas.
There are many different methods used to correct vocal cord abnormalities. These can include using forceps (like tweezers) to hold a bump or nodule and small scissors or the CO2 laser (see below) may be used to remove it. Powered instruments may also be used to remove lesions. These rotating blades remove growths such as papillomas with very little damage to normal tissue.
Defects on the vocal cords or surrounding areas may be repaired by injections, flaps of tissue, or grafts depending on the size of the defect.
The surgery itself usually lasts about an hour, but is highly variable. Removal of nodules or bumps or more simple reconstructive procedures may not require an overnight stay in the hospital. More complex procedures may require a hospital stay.
What is the CO2 laser?
Laser stands for “light amplification by stimulated emission of radiation”. The CO2 laser device increases the intensity of light waves using CO2 (carbon dioxide) and concentrates them in an intense, penetrating beam of light. This is similar in a way to using a magnifying glass to concentrate the sun’s rays; the “concentrated” sun rays underneath the magnifying glass get hot enough to burn paper for example. Similarly, the CO2 laser beam can be used to very accurately “burn off” areas of tissue that need to be removed, (vaporized).
Why is the CO2 laser used in vocal cord surgery?
The CO2 laser can be passed through the glass of the operating microscope, allowing for very accurate placement of the laser beam on the vocal cords. This method of tissue removal is much more precise than surgical scissors, and results in less bleeding and inflammation to the surrounding tissues. As mentioned previously, the less traumatic the surgical procedure, the more favorable the outcome, including faster recovery.
What are the risks of using the CO2 laser?
Although the laser can precisely vaporize the desired tissue, it can also accidentally burn basically anything else it may come in contact with. Therefore, safety precautions have been made to avoid this complication. These safety precautions include protective eye gear for both the patient and the operating team. A wet cloth may also be placed over the patient’s face and eyes. Also, as the breathing tube can catch on fire, these surgeries are usually performed without a breathing tube in place while the laser is in use. In addition, the lowest amount of oxygen needed is used during the procedure.
What are the risks and complications of vocal cord surgery?
The risks with the use of the CO2 laser are described above. The short-term risks of vocal cord surgery in general include chipped teeth (protective teeth guards are used during surgery to help prevent this), bleeding, breathing difficulties, hoarseness, change in voice quality, or infection.
Long term risks include a less than desired outcome in regaining normal voice or scarring from the surgery that may need additional surgical repair in the future.
Your Pediatric ENT surgeon will discuss these with you in detail.
What is involved with recovery after vocal cord surgery?
Recovery after vocal cord surgery is dependent on the surgical procedure, as well as how well inflammation and swelling are controlled after the surgery. Your Pediatric ENT surgeon will give you guidelines on how to start reusing your voice. It is important to follow to these guidelines and keep all recommended follow up appointments to regain optimal vocal cord function.
Thomas M. Andrews
Dr. Andrews specializes in the medical and surgical treatment of ear, nose and throat disorders of children and adolescents. His accreditations include Florida State Medical License and Ohio State Medical License. He is also a board member of the National Board of Medical Examiners and American Board of Otolaryngology, Head and Neck Surgery