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Who has voice surgery?

Surgery for voice problems is usually for patients with persistent voice symptoms that have not or will not respond to voice therapy.  


Consent for Surgery

If your ENT surgeon feels that your voice problem requires surgery, you will be asked to sign a consent form. Please read this carefully and ask any questions that arise.

 

 

There are two types of laryngeal surgery 

  1. Endoscopic surgery - throughout the mouth with no cuts in the neck
  2. Open laryngeal surgery - through a small cut in the neck

 


 1. Endoscopic Voice Surgery

 


While the patient is under anesthetic, an endoscope with a camera is put through the mouth and down the throat. This allows the surgeon to use surgical instruments or a laser on the vocal folds. This type of surgery is used for the removal of polyps, cysts, papillomas, granulomas or other laryngeal growths.


 
 

 


Laser surgery

Polyps ,granulomas, cysts and nodules are removed with micro-instruments or the KTP green light laser. The latter is very gentle and safe and is designed so that no damage can occur to the vocal folds  ie. it is low temperature and an is taken up by vascular tissue so the procedure is bloodless.


1. a vocal cord polyp and 2. microsurgical removal of a vocal cord lesion. For granulomas, an injection of anti-inflammatory steroid (Depo-Medrol) Into the lesion is performed. Complete vocal fold rest by using Botox should complete treatment
1  
1. a vocal cord polyp
 
2
2. microsurgical removal of vocal cord lesion

 


Microflap Techniques



Preserved vibrating edge of vocal fold mucosa X 40 power 




During endoscopic surgery the surgeon will use a microflap techniques which is designed to minimise the impact of any vocal fold surgery on the delicate structures of the larynx.  A high powered microscope is used, local anaesthetic spray is used on the vocal folds to reduce any coughing, no endotracheal tube is used ie the patient is asleep but still breathing on their own.


VOICE REST WILL BE ADVISED BY SURGEON





Endoscopic Injections

Injections for the temporary treatment for paralysed vocal fold, vocal fold bowing or vocal fold paresis

For an effective voice the vocal folds must meet each other in the midline. To achieve good vocal fold closure it may be necessary to bulk out one or both vocal folds. Many substances can be used including the patient’s own fat or commercially available substances such as Vox or Restylane or Perlane


At the Voice Assessment Centre the material of choice is RESTYLANE or 1% Hyaluronic acid. It is a naturally occurring  substance found the body. Restylane can be the injected into the vocal folds safely and quickly. Bulking out the vocal folds with Restylane has a significant effect on the voice allowing patients to resume their normal voice use.


After any laryngeal surgery, always check with your surgeon how long you will need to rest your voice. Don’t whisper as an alternative to talking.

Pre and post-op voice therapy is absolutely essential to prevent recurrence of the problem and return to normal voice use. This may take a number of weeks but will be determined by your voice therapist.



 2. Open Laryngeal Surgery

Laryngeal framework surgery/laryngofissure is performed through a small external cut to the skin to access the larynx.  This allows the surgeon to manipulate the vocal folds from the outside.  The inside of the larynx is not touched so there is no trauma to the vocal folds.  The laryngeal cartilages are manipulated either to widen or narrow the gap.


Medialisation: This surgery is most often undertaken in patients who have a vocal fold paralysis; the damaged fold is pushed into the midline to allow the functioning vocal fold to meet it. A local anaesthetic is used; the patient remains awake so that the voice can be tested during the operation. Surgical grade materials such as silastic or goretex are inserted to maintain the desired voice.

 


The normal cartilage of the larynx, with the side of the vocal cords indicated by the dotted line.

A window in the laryngeal cartilage allows implant insertion at the level of the vocal cords in a medialisation procedure.


The implant insertion to medialise the paralysed left vocal fold.

(pictures courtesy of J. Kaufman MD FACS)

 

 
In some patients there is a large gap at the back of the larynx.  This needs to be closed by an additional procedure called arytenopexy or arytenoid adduction.
 
Transgender procedures : Reduction of laryngeal prominence and pitch elevation in male-female transexuals.