CPT® Code 31395

The procedure described by CPT® Code 31395 is a pharyngolaryngectomy combined with a radical neck dissection (RND) and includes reconstruction. A pharyngolaryngectomy is a surgical operation that entails the removal of the larynx, which is the organ responsible for voice production, along with a segment of the pharynx, the part of the throat situated behind the mouth and nasal cavity. This procedure is primarily indicated for patients diagnosed with laryngeal cancers that have either invaded the pharynx or have metastasized to this area. In some cases, it may also be performed due to severe injuries to the throat or neck or other diseases that necessitate the excision of these structures, although such instances are less common. Prior to the pharyngolaryngectomy, a tracheostomy is typically performed to facilitate the administration of anesthesia and to ensure an airway is established. The surgical approach involves making a horizontal incision in the neck at the level of the thyroid cartilage, allowing the surgeon to raise subplatysmal flaps and expose the larynx for dissection. During the procedure, various anatomical structures, including the delphian node, thyroid gland, hyoid bone, and thyroid cartilage, are removed as part of the radical neck dissection. This dissection involves the excision of lymph node groups from levels I to V, as well as the removal of surrounding tissues such as the sternocleidomastoid muscle, internal jugular vein, and submandibular gland. The surgical technique also includes entering the larynx, which is dictated by the extent of the disease, and subsequently removing it along with the identified portion of the pharynx. After the excision, a tracheostoma is created to allow for breathing, with the trachea being externalized and sutured to the skin at the sternal notch. In contrast to CPT® Code 31390, where reconstruction is not performed, CPT® Code 31395 involves reconstructing the pharynx and larynx during the same surgical session. This reconstruction may utilize advancement flaps from remaining pharyngeal tissue or myocutaneous flaps from areas such as the chest, back, or forearm, ensuring that the surgical site is effectively closed and functional post-operation.