CPT® Code 31551

1. Indications

The procedure described by CPT® Code 31551 is indicated for the treatment of laryngeal stenosis in patients younger than 12 years of age. The specific indications for performing this laryngoplasty include:

• Congenital Laryngeal Stenosis - This condition is characterized by the failure of the laryngeal lumen to recanalize after the epithelial lamina forms, often resulting in narrowing primarily in the subglottic area.
• Acquired Laryngeal Stenosis - This may occur due to various factors such as trauma from endotracheal intubation, gastroesophageal reflux, infections, autoimmune disorders, malignancy, amyloidosis, inhalation burns, or radiation exposure.
• Symptoms of Airway Obstruction - Patients may present with inspiratory or biphasic stridor, apnea, tachypnea, dyspnea, voice hoarseness, aphonia, and dysphagia, indicating the need for surgical intervention to restore airway patency.

2. Procedure

The laryngoplasty procedure for CPT® Code 31551 involves several critical steps to effectively address laryngeal stenosis:

• Step 1: Anesthesia and Preparation - The patient is placed under general anesthesia, and an endotracheal tube is inserted to maintain airway patency during the procedure.
• Step 2: Incision and Exposure - An incision is made at the level of the larynx to expose the thyroid cartilage, allowing access to the affected area.
• Step 3: Drilling the Cartilage - Using a burr, a window is drilled in the thyroid cartilage, specifically posterior to the midline and above the lower edge of the thyroid, to facilitate access to the stenotic area.
• Step 4: Undermining the Perichondrium - The perichondrium is carefully undermined posterior and inferior to the drilled window to prepare for graft placement.
• Step 5: Visualization and Dissection - An endoscope is utilized to visualize the larynx, including the glottis and cricoarytenoid joints, allowing for precise dissection of the area of stenosis to remove any membranous webs or excess cartilage.
• Step 6: Graft Preparation and Placement - A graft is fashioned from autogenous costal cartilage, auricular cartilage, thyroid cartilage, or buccal mucosa, which is obtained during a separately reported procedure. This graft is then sutured in place to reconstruct the airway.
• Step 7: Closure - After the graft is secured, the endoscope is removed, and the incision is closed, completing the procedure.

3. Post-Procedure

Post-procedure care following laryngoplasty under CPT® Code 31551 involves monitoring the patient for any signs of complications, such as airway obstruction or infection. Patients may require close observation in a hospital setting, especially in the immediate postoperative period, to ensure that the airway remains patent and that the graft is healing appropriately. Follow-up appointments are essential to assess the success of the procedure and to monitor for any recurrence of stenosis or other complications. The healthcare team will provide specific instructions regarding activity restrictions, signs of complications to watch for, and any necessary follow-up imaging or evaluations to ensure optimal recovery.