CPT® Code 31380

1. Indications

The antero-vertical hemilaryngectomy (CPT® Code 31380) is indicated for patients diagnosed with specific types of laryngeal cancer. The following conditions may warrant this surgical intervention:

• Localized Laryngeal Cancer The procedure is performed for cancers that are confined to one side of the larynx, particularly those involving the anterior commissure and vocal processes of the arytenoid cartilage.
• Supraglottic Cancer In cases where supraglottic cancer is present, and it is determined that a partial laryngectomy can effectively remove the tumor while preserving surrounding structures.
• Glottic Cancer The procedure may also be indicated for glottic cancers that require resection of the anterior aspect of the larynx.

2. Procedure

The antero-vertical hemilaryngectomy (CPT® Code 31380) involves several critical procedural steps to ensure the effective removal of cancerous tissue while preserving as much of the laryngeal function as possible. The following steps outline the procedure:

• Step 1: Anesthesia and Tracheostomy Prior to the surgical procedure, the patient is placed under general anesthesia. A tracheostomy may be performed to secure the airway and facilitate ventilation during the surgery.
• Step 2: Incision A vertical incision is made in the neck, extending from the midline of the transverse incision to provide adequate exposure of the larynx. This incision allows the surgeon to access the laryngeal structures effectively.
• Step 3: Entry into the Larynx The larynx is accessed through a transverse incision made in the cricothyroid membrane, which is located below the glottis. This entry point is crucial for the subsequent resection of tissue.
• Step 4: Resection of Tissue The surgeon carefully resects the affected tissue, which includes the anterior commissure and part of the contralateral vocal cord. The resection is performed with precision to ensure that all cancerous tissue is removed while minimizing damage to surrounding healthy structures.
• Step 5: Closure After the resection is complete, the surgical site is closed by reapproximating the remaining laryngeal structures. Drains may be placed to prevent fluid accumulation, and the skin incisions are sutured closed.

3. Post-Procedure

Following the antero-vertical hemilaryngectomy, patients typically require close monitoring in a recovery area. Post-operative care includes managing the tracheostomy, if performed, and monitoring for any signs of complications such as bleeding or infection. Patients may experience changes in their voice and swallowing function due to the extent of the tissue resection. Speech therapy may be recommended to assist with voice rehabilitation. The expected recovery period can vary, and follow-up appointments are essential to assess healing and any further treatment needs.