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A laryngoplasty is a surgical procedure that involves the modification of the larynx, specifically utilizing a technique known as cricoid split. This particular approach is characterized by the splitting of the cricoid cartilage, which is a vital structure that forms a complete ring around the trachea. The primary indication for performing this procedure is to address congenital subglottic stenosis, a condition where the airway is narrowed due to an underdeveloped cricoid ring. Patients undergoing this procedure are typically already intubated as a result of the airway obstruction caused by the stenosis. The surgical technique begins with a horizontal incision made over the larynx, precisely at the level of the cricothyroid membrane, allowing the surgeon to access the underlying structures. A subplatysmal apron flap is then created and elevated to provide sufficient exposure of the cricoid cartilage. The procedure involves careful dissection to expose the cricoid cartilage and upper trachea by dividing the strap muscles along the midline and retracting them laterally. A vertical incision is made through the lower two-thirds of the thyroid cartilage, the cricoid, and the first two tracheal rings, which effectively relieves the stenosis. After the necessary incisions are made, they are meticulously closed in layers to ensure proper healing. Throughout the entire procedure, the patient remains intubated, and this intubation is typically maintained for approximately 10 days post-operatively to ensure airway stability and support during the recovery phase.
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The laryngoplasty procedure using the cricoid split technique is primarily indicated for the treatment of congenital subglottic stenosis, which is characterized by a narrowing of the airway due to an underdeveloped cricoid ring. This condition can lead to significant respiratory distress and requires surgical intervention to restore adequate airflow.
The laryngoplasty procedure begins with the patient being intubated due to the existing airway obstruction. A horizontal skin incision is made over the larynx at the level of the cricothyroid membrane, which allows access to the underlying structures. Following this, a subplatysmal apron flap is created and elevated to the level of the thyroid notch, providing adequate exposure of the cricoid cartilage. The next step involves exposing the cricoid cartilage and upper trachea by carefully dividing the strap muscles in the midline and retracting them laterally. This dissection is crucial for accessing the area that requires intervention. A vertical midline incision is then made through the inferior two-thirds of the thyroid cartilage, the cricoid, and the first two tracheal rings. This incision is essential for relieving the stenosis and restoring normal airway patency. After the necessary incisions are made, they are closed in layers to ensure proper healing and minimize complications. Throughout the entire procedure, the patient remains intubated to maintain airway support, and this intubation is typically continued for approximately 10 days following the procedure to ensure adequate recovery and airway stability.
After the laryngoplasty procedure, the patient remains intubated for approximately 10 days to ensure airway stability and support during the recovery phase. This extended intubation period is critical for monitoring the patient's respiratory status and allowing the surgical site to heal adequately. Post-operative care may include close observation for any signs of complications, such as infection or airway obstruction, and management of pain as needed. The healthcare team will also assess the patient's ability to breathe independently before extubation, ensuring that the airway is patent and that the patient can maintain adequate oxygenation.
| Short Descr | LARYNGOPLASTY CRICOID SPLIT | Medium Descr | LARYNGOPLASTY CRICOID SPLIT W/O GRAFT PLACEMENT | Long Descr | Laryngoplasty, cricoid split, without graft placement | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 42 - Other OR therapeutic procedures on respiratory system |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2017-01-01 | Changed | Long, Medium and Short descriptions changed. |
| Pre-1990 | Added | Code added. |
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