CPT® Code 31553

1. Indications

The procedure described by CPT® Code 31553 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 stenosis primarily in the subglottic area.
• Acquired Laryngeal Stenosis - This may arise from various causes, including trauma during endotracheal intubation, gastroesophageal reflux, infections, autoimmune disorders, malignancies, amyloidosis, inhalation burns, or radiation exposure.
• Symptoms of Laryngeal Stenosis - Patients may present with inspiratory or biphasic stridor, apnea, tachypnea, dyspnea, voice hoarseness, aphonia, and dysphagia, which necessitate intervention to restore airway patency.

2. Procedure

The laryngoplasty procedure for laryngeal stenosis involves several critical steps to ensure effective treatment. The following procedural steps are performed:

• Step 1: Anesthesia and Incision - The procedure begins with the administration of anesthesia, followed by the placement of an endotracheal tube to secure the airway. An incision is then made at the level of the larynx to provide access to the thyroid cartilage.
• Step 2: Drilling the Thyroid Cartilage - A burr is utilized to drill a window in the thyroid cartilage, specifically posterior to the midline and above the lower edge of the thyroid. This step is crucial for accessing the area of stenosis.
• Step 3: Undermining the Perichondrium - The perichondrium is carefully undermined posterior and inferior to the drilled window, allowing for better visualization and access to the larynx.
• Step 4: Visualization with Endoscope - An endoscope is introduced to visualize the larynx, including the glottis and cricoarytenoid joints, which aids in assessing the extent of the stenosis.
• Step 5: Dissection of Stenotic Area - The area of stenosis is meticulously dissected to remove any membranous webs or excess cartilage that may be contributing to the airway narrowing.
• Step 6: Graft Preparation and Placement - A graft is fashioned from autogenous tissue, which may include costal cartilage, auricular cartilage, thyroid cartilage, or buccal mucosa. This graft is then sutured in place to reconstruct the airway.
• Step 7: Stent Placement - To secure the graft and expand the reconstructed area, a stent made of molded silicone or Teflon may be placed in the airway. Alternatively, an endotracheal tube may be left in place to stent the airway during the initial recovery phase.
• Step 8: Closure - After ensuring that the graft is secure and the airway is adequately stented, the endoscope is removed, and the incision is closed to complete the procedure.

3. Post-Procedure

Post-procedure care following a laryngoplasty for laryngeal stenosis includes monitoring the patient for any signs of complications, such as infection or airway obstruction. The patient may require close observation in a hospital setting, especially in the immediate recovery phase. The indwelling stent or endotracheal tube will typically remain in place for a specified duration to maintain airway patency and support the healing of the graft. Follow-up appointments are essential to assess the success of the procedure, monitor for any recurrence of stenosis, and evaluate the overall recovery of the patient's airway function and voice quality. Additional interventions may be necessary based on the patient's progress and any complications that may arise during the recovery period.