CPT® Code 31365

The procedure described by CPT® Code 31365 refers to a total laryngectomy performed in conjunction with a radical neck dissection (RND). In this surgical intervention, the entire larynx, commonly known as the voice box, is completely excised. 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 carefully dissect it free from the surrounding tissues. During this process, several critical anatomical structures are addressed: the delphian node is removed, the thyroid gland is resected, and the hyoid bone is excised. Additionally, the thyroid cartilage is skeletonized to facilitate access to the larynx. The entry point into the larynx is determined by the specific location and extent of the disease being treated. Once the larynx is fully accessed, it is removed in its entirety. After the laryngectomy, the surgical wound is closed, and a laryngostoma is created. This involves making a separate incision below the initial laryngectomy incision, through which the trachea is externalized and sutured to the skin at the sternal notch. This procedure results in a permanent stoma, allowing the patient to breathe directly through the trachea, bypassing the removed larynx. It is important to note that CPT® Code 31360 is designated for cases where a total laryngectomy is performed without the accompanying radical neck dissection, while CPT® Code 31365 is specifically used when RND is included in the surgical approach. The radical neck dissection typically involves the excision of lymph node groups levels I-V, as well as the removal of the sternocleidomastoid muscle, internal jugular vein, submandibular gland, and potentially other muscles such as the anterior belly of the digastric, sternohyoid, and sternothyroid muscles.