Microlaryngoscopy (MLS) is a medical procedure used in the fields of otolaryngology, phoniatrics (the study of voice healing), and phonosurgery (surgical procedures on the vocal apparatus). It is used for both diagnostic observation and therapeutic treatment of the larynx (laryngeal apparatus). Microlaryngoscopy allows, among other things, the taking of biopsies, as well as the complete surgical removal of benign (benign) and malignant (malignant) changes in the area of the larynx.
Indications (areas of application)
- Ablation of benign (benign) tissue changes – e.g., fibromas (proliferation of connective tissue cells), hyperkeratoses (excessive keratinization), polyps, or vocal fold nodules (synonyms: vocal cord nodules; singer’s or screamer’s nodules); these are more or less symmetrical elevations at the edge of the vocal folds, similar to the cornea on the skin
- Reinke’s edema (edema of the vocal fold margin in the so-called Reinke’s space, a slit-shaped space between the epithelium and the underlying connective tissue) – typical, glassy-lobed swelling of the vocal folds of varying degrees. Symptoms: Decrease in the middle pitch of speech, the voice sounds rough-hoarse (dysphonia). If the edema (swelling) increases, aphonia (voicelessness) is possible. Due to the narrowing of the glottis (glottis), breathing problems may occur as an additional complication.
- Removal of scars, synechiae (adhesions).
- Assessment of tumor extension in malignant ulcers (e.g., vocal fold carcinoma).
- Surgical procedures on the larynx (larynx).
- Trial excision (biopsy)
Contraindications
- General diseases that stand in the way of anesthesia.
- Diseases that prohibit maximum reclination of the head (e.g., disc prolapse/herniated disc of the cervical spine)
- Lockjaw (trismus) – difficult mouth opening, e.g., local inflammation of the masticatory muscles.
- Too tight larynx
The surgical procedure
Microlaryngoscopy is performed under general anesthesia. The patient is lying on his back while the examining physician stands behind his head. The patient’s shoulder girdle is placed in a slightly elevated position, and the head is maximally reclined (“placed in the neck“). If a dental prosthesis is present, it is removed, and the patient’s healthy dentition is protected with a dental splint. The patient is first intubated with a thin tube (insertion of a plastic tube into the trachea for ventilation). Now a rigid tube (e.g. Kleinsasser instrument) is advanced into the patient’s mouth past the tongue to the larynx. Once the Kleinsasser tube is correctly placed, it is secured to the patient’s chest with a chest support. A surgical microscope (or endoscope) is then pushed through to give the surgeon the desired view of the larynx. Now, in addition to inspection, surgical procedures can be performed in the laryngeal area.
After surgery
- After microlaryngoscopy, the patient should take care of his voice, although this measure depends on the type of surgery performed on the laryngeal apparatus.
- Possibly, a logopedic treatment (speech therapy) can take place.
- To prevent irritable cough, antitussives (drugs that dampens or quiets the cough) can be given; corticosteroids prevent dangerous edema formation (swelling).
Possible complications
- Mediastinitis (inflammation of the mediastinum).
- Dysphonia (hoarseness)
- Dyspnea (shortness of breath; breathlessness)
- Tracheostomy/coniotomy (tracheotomy) with insertion of a tracheal cannula (tracheal tube).
- Pneumonia (pneumonia)
- Scarring and synechiae
- Recurrence (recurrence of the disease).
- Aphonia (loss of voice; voicelessness).
- Mucosal lesions
- Dysphagia (swallowing disorder)
- Damage to the following nerves: lingual nerve, hypoglossal nerve, glossopharyngeal nerve.
- Injury to the palate
- Tooth damage, tooth loss
