Direct (Operative) Laryngoscopy and Bronchoscopy

What is a rigid laryngoscopy and bronchoscopy?

Laryngoscopy and Bronchoscopy is an examination of the voice box (larynx) and windpipe (trachea and bronchi) through a rigid lighted telescope. This procedure is typically performed in the Operating Room under general anesthesia. This procedure allows detailed examination of the large portions of the airway. Some treatments can be performed or samples can be taken during this procedure as well. Your surgeon will discuss with you whether this procedure is planned for diagnosis only or if treatment is planned. Sometimes this procedure is performed in conjunction with a Flexible Bronchoscopy performed by a Pediatric Pulmonologist.

Why would my child need laryngoscopy and bronchoscopy?

Diagnostic laryngoscopy and bronchoscopy is performed to evaluate the large airways, typically when there is concern about narrowing or collapse of the airways. If tracheomalacia, subglottic stenosis, or other airway lesions are suspected, your physician will likely recommend this procedure. Photographs and video can also be taken to document the findings. Evaluation of certain voice problems may also necessitate laryngoscopy and bronchoscopy.

At other times, biopsy or removal of a lesion in the airway may be recommended. This can often be done with rigid laryngoscopy and bronchoscopy. Certain treatments, such opening or dilating the airway in cases of laryngomalacia or subglottic stenosis can also be performed. Foreign bodies can also be removed from the airway with rigid laryngoscopy and bronchoscopy.

Why would my child need a rigid scope, if he/ she already had a flexible scope in the office?

An in office Flexible Laryngoscopy or Nasopharyngoscopy assesses the nose, throat, and voice box, down to the level of the vocal cords. It provides excellent assessment of these structures in an awake patient. It is the best way to evaluate movement of the vocal cords. After this test is done, your surgeon may recommend a rigid scope to evaluate the airway below the vocal cords. Also, if a lesion is noted on or above the vocal cords it can be removed or biopsied with an operative laryngoscopy and bronchoscopy.

What should I expect on the day of the procedure?

Your child will have surgery in the Main Operating Room at Nationwide Children’s Hospital. The procedure may last only 20-30 minutes, but can take much longer depending on procedures planned. Your surgeon will give you an idea of how much time is expected, but this may change during the procedure.

Before and after surgery: Our pediatric nurses will prepare your child for surgery, assist the pediatric ENT surgeon during surgery, and care for your child after the procedure.

Anesthesiology: Your child will be placed under general anesthesia by a pediatric anesthesiologist. Our subspecialty-trained pediatric anesthesiologists regularly provide pediatric anesthesiology services for patients undergoing surgical procedures. You will meet the anesthesiologist who will be taking care of your child prior to the procedure.

Surgery: A Pediatric ENT surgeon will use specialized telescopes to systematically evaluate the airway. If additional procedures are needed, special instruments will be used through the telescopes to perform these procedures.

What should I expect after my child has a laryngoscopy and bronchoscopy?

After Surgery: Your surgeon may feel it is safe for you to go home after the procedure, or may recommend that he/ she be observed at the hospital for a period of time afterwards. On rare occasions, a breathing tube may be placed after surgery. Your surgeon will discuss the postoperative plan with you after the procedure. Follow up plans will be discussed as well.

Your child may be more sleepy than usual. Your child’s voice may be hoarse or he/ she may have a sore throat. A slight fever after anesthesia is normal. Encourage your child to drink plenty of liquids after the procedure. Your surgeon will discuss when he/ she should return to a normal diet. Tylenol or ibuprofen is typically appropriate for pain control.

If your child develops any concerning symptoms after surgery, including pauses in the breathing, color change of the skin (particularly if the lips, face, or hands are turning blue), appearing lethargic or tired, or any other sudden change from his/ her normal breathing pattern, please seek immediate medical attention.

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