CPT® Code 31360

The procedure described by CPT® Code 31360 refers to a total laryngectomy, which is a surgical operation involving the complete removal of the larynx, commonly known as the voice box. This procedure is typically indicated for patients with laryngeal cancer or other significant laryngeal diseases that necessitate the removal of the entire laryngeal structure. The operation begins with a horizontal incision made in the skin of the neck, specifically at the level of the thyroid cartilage, which is a prominent structure in the neck. Following the incision, subplatysmal flaps are raised to expose the larynx, allowing the surgeon to dissect it free from the surrounding tissues. During the procedure, the delphian node, which is a lymph node located in the midline of the neck, is excised, along with the thyroid gland and the hyoid bone. The thyroid cartilage, which provides structural support to the larynx, is also skeletonized, meaning that the surrounding tissues are carefully removed to isolate the cartilage. The entry point into the larynx is determined by the specific location and extent of the disease present. Once the larynx is completely removed, the surgical wound is closed, and a laryngostoma is created. This involves making a separate incision below the initial incision to externalize the trachea, which is then sutured to the skin at the sternal notch. This creates a permanent stoma, allowing the patient to breathe directly through the trachea, bypassing the removed larynx. It is important to note that this code is specifically used when the total laryngectomy is performed without a radical neck dissection (RND), which is a more extensive procedure involving the removal of lymph nodes and surrounding structures in the neck.