Intubation after voice surgery

[anjaq]

Hi.
I read a lot now that intubation after a voice surgery with glottoplasty (like it is done at Yesons for example) requires a smaller intubation pipe and has to be done more carefully. Now if you are planning a surgery like this, it may be manageable. I guess you would have to wait a year after VFS to have another surgery so it has all healed well and then you can request a smaller intubation when doing lets say FFS or GRS later.

So I wonder about two things:
* will intubation later on still be a risk for the surgery site? It is held together with threads after all and they shove a plastic pipe next to that into the windpipe, which probably moves around as well during a surgery - is there a risk?

* but the other more worrying thing is, that apparently in emergency surgeries they use a tube of a size that takes the larynx as a guesstimate. Post VFS the larynx is in disproportion to the vocal fold opening. Thus it would damage the vocal chords and the surgery site. Are there ways to ensure that in an emergency situation they are informed of that issue? I mean, others have allergies, pacemakers, diabetes and such conditions that in an emergency should be known to the emergency helpers. Do they have some form of card to put in the pocket or a microchip or bracelet or anything that stores such data? I would especially be interested in EU solutions as I am living here.

Thanks
Byew

[Charlotte]

Hello Anja, I wonder about this as well. I'm not sure if it's much help but here are a few things that occured to me:

1. Laryngeal web is a congenital malformation of the larynx which for practical purposes is very similar to VFS. Lots of people are walking around with a laryngeal web quite happily not knowing they have this. So anesthesiologists are aware of this issue during intubation.
2. Everybody can get they're vocal cords damaged by rough intubation VFS or no VFS; I think if the surgeon rotates your head during surgery it's a particular problem. If you're a singer you're suppose to tell the anesthesiologist so they can use a smaller tube & packing.
3. Women manage just fine with smaller larynxs.

Just my 2 cents.

[Jessica Merriman]

Hi. The rule of thumb for us Paramedics was a endotracheal tube the size of your index finger. Usually for cis women it is a size 5-6.5. You should be OK as the anesthesia will relax the chords and so no damage should occur. If you do get surgery of any kind do tell the Anesthesiologist and Surgeon though. As far as emergency conditions there are no medic alert bracelets for VFS notification to emergency responders. If you are worried though one may possibly be custom made by calling the bracelet provider directly. Your Pharmacist should be able to give you the company's info. In an emergency though being tubed and your life saved is the first priority.

[anjaq]

I think #1 is rare, so maybe they do not care too  much about it and probably that natural webbing is more stable?
#3 is not the point as they would judge the size of the zube by the larynx and the larnyx size does not change with glottoplasty. So it would still be male-sized but with female sized vocal fold opening. Thats the issue I was asking about. Other women have a smaller larynx, so they could judge this more correctly

Index finger correlates to vocal fold opening size? Thats odd.

[Charlotte]

I guess the point with larnyx sizes is that I don't know how you can tell whether you have a big or small larnyx without putting a camera down there. I mean I have no idea whether my larnyx is big or small - I'm guessing big because of the low pitch, but I have small fingers.  Confused!

[anjaq]

My fingers dont look big but apparently they are if I try to shop for rings. Same with my larynx - it does not look that big, no "adams apple" at all - but with the camera today the ENT said the vocal folds are "male sized"...