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Surgery

Surgery

There are two basic types of surgery in voice medicine, microlaryngoscopy andlaryngoplasty. These are discussed in general terms below. You should discuss the particular aspects of your case, including expected outcomes and risks, with your surgeon.

Microlaryngoscopy

Microlaryngoscopy is a technique used in the diagnosis and removal of various lesions of the vocal folds, including (but not limited to)

It is the most precise means of operating on the vocal folds and allows the use of two of the most essential and important tools in voice surgery: the microscope and microscopic instruments. All surgery is done via a laryngoscope, an instrument inserted through the mouth, and there are no skin incisions.

surgery

Microlaryngoscopy: The surgeon is looking through an operating microscope and using fine microinstruments to remove a vocal fold polyp. The patient is under general anesthesia.

Microlaryngoscopy requires general anesthesia, but patients generally go home the same day as the procedure. It typically takes approximately one hour. Pain after surgery is not severe, and rarely requires more than over the counter pain relievers. Complications include temporary numbness or tingling of the tongue, and damage to teeth, especially if there are crowns or if the teeth are in poor condition to begin with. The most challenging complication is vocal fold scar.

The use of the carbon dioxide laser for surgery of the vocal fold is a subject of controversy. Two thirds of otolaryngologists prefer to avoid it, for although the cutting beam is reasonably precise, it is hypothesized that the tissue reaction is somewhat unpredictable, probably because of the emitted heat. The alternative is microscopic instruments. Although they are more technically difficult to use, they offer equivalent accuracy and perhaps less potential for inadvertent damage and scar.

Laryngoplasty

Laryngoplasty describes a surgery which changes the shape or configuration of the larynx and vocal folds. In most cases, the operation is used to reposition a paralyzed vocal fold to a position that is better for voice production, known as medialization laryngoplasty. This may involve placement of an implant and/or sutures to readjust the position of laryngeal cartilages. Laryngoplasty usually requires a skin incision in the neck. The size and location of this incision depends on the type and extent of laryngoplasty being performed.

A variety of implantable materials are available for laryngoplasty, including silicone, Gore-Tex™, and a substance called calcium hydroxylapatite. None has a clear advantage over another, but there are various considerations in implant selection. The advisability of repositioning certain cartilages (known as arytenoid adduction) and variations in technique are also debated among laryngologists. Both of these issues may be discussed with your surgeon.

Because the larynx typically swells after such a surgery, patients are usually observed in the hospital overnight to make sure no difficulty breathing develops. This is a very rare but potentially dangerous complication, so every precaution is taken. Because a foreign substance is usually implanted in a laryngoplasty, infection is also a consideration. Practically, however, the main difficulty of the operation lies in obtaining the best voice result. A suboptimal voice result is the most common reason this operation is repeated or revised.

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