Phonosurgery
Phonosurgery refers to a range of surgical procedures designed to maintain, restore, or enhance the human voice. These procedures are used to treat voice disorders caused by structural issues in the vocal cords or larynx.
Phonosurgery includes:
- Phonomicrosurgery: Microsurgery of the vocal folds performed using a microscope or endoscope for precise, minimally invasive treatment.
- Laryngoplasty Phonosurgery: Open-neck surgery that restructures the cartilaginous framework of the larynx and soft tissues to improve vocal function.
- Laryngeal Injection: Injections into the larynx of medications or biologic substances to improve vocal cord function and voice quality.
- Reinnervation: The restoration of nerve supply to the larynx, often used in cases of vocal cord paralysis.
The term “phonosurgery” was first coined in the early 1960s and has since evolved to include advanced techniques that enhance vocal health and performance
Phonosurgery: Enhancing Voice Quality Through Surgical Techniques
Phonosurgery is a surgical procedure aimed at improving voice quality. It encompasses various techniques, including phonomicrosurgery, laryngoplasty, injection procedures, and laryngeal reinnervation. This article primarily focuses on phonomicrosurgery, which utilizes an operating microscope and micro-instruments for endoscopic laryngeal surgery. Additionally, emerging office based techniques for managing vocal fold lesions are briefly discussed.
Phonomicrosurgery: A Delicate Approach
Phonomicrosurgery involves the careful evaluation of vocal pathology using rigid telescopes or an operating microscope. During the procedure:
- The lesion is excised with precision, limiting dissection to the most superficial plane possible.
- Epithelium (outermost layer) and lamina propria (underlying layer) are preserved to minimize scarring.
- The goal is to remove vocal fold lesions while maintaining optimal voice function.
Why Would You Need Phonosurgery?
Phonosurgery may be recommended for individuals experiencing:
- Weak or unstable voice
- Permanent hoarseness
- Vocal instability
- Pitch modification needs (e.g male-to-female voice transition)
Types of Phonosurgery
Phonomicrosurgery
This technique, also known as microflap surgery, is used to remove polyps, cysts, and other vocal fold lesions.
- A microscopic flap is lifted from the epithelium (outer layer of vocal cords).
- The lesion is precisely removed, ensuring minimal scarring.
- The epithelium is repositioned, preserving vocal cord function and voice quality.
This method is highly effective in restoring normal voice function with minimal damage to surrounding tissues.
Laryngoplastic Phonosurgery (Thyroplasty)
Thyroplasty is performed to strengthen or modify the voice using an implant inside the larynx.
- A small incision is made in the neck to access the larynx.
- An implant is placed near the vocal cord, pushing it closer to the middle to enhance vocal strength.
- The patient remains awake under local anesthesia so their voice can be monitored throughout the procedure.
Pitch Modification: In cases of puberty dysphonia, where a male voice remains high-pitched, thyroplasty helps lower the pitch by shortening the vocal cords.
Laryngeal Injections
Laryngeal injections are used to treat weak or paralyzed vocal cords by enhancing vocal cord bulk.
- Injection materials (such as hyaluronic acid, fat) are placed into the tissue surrounding the vocal cords.
- This helps bring the vocal cords closer together, improving voice strength and clarity.
This method is commonly used for patients with vocal cord paralysis or atrophy.
Phonosurgery offers various techniques to address voice disorders, vocal cord lesions, and pitch-related concerns. Whether through phonomicrosurgery, thyroplasty, or laryngeal injections, these procedures help restore voice strength, clarity, and natural tone, improving overall communication and quality of life.
Thyroplasty types
Thyroplasty, a surgical procedure involving the larynx, has four main types, each addressing specific voice or laryngeal issues: Type I (medialization), Type II (lateralization), Type III (shortening/relaxation), and Type IV (elongation/tensioning).
Type I (Medialization):
This involves moving the vocal cord inward, closer to the midline, to improve voice quality and address issues like vocal cord paralysis or atrophy.
- Indications: Unilateral vocal cord paralysis, vocal cord atrophy, dysphonia.
- Procedure: A rectangular incision is made on the thyroid cartilage, and a fragment is depressed inward, potentially using a cartilage piece from the opposite side as a wedge.
- Materials: Titanium implants or Gore-Tex are sometimes used for medialization.
Type II (Lateralization):
This procedure involves moving the vocal cord outward, away from the midline, and is used to address airway insufficiency after laryngeal trauma or spasmodic dysphonia.
- Indications: Airway insufficiency after laryngeal trauma, spasmodic dysphonia.
Type III (Shortening/Relaxation):
This procedure shortens or relaxes the vocal cords, leading to a lower voice pitch, and is sometimes used in voice masculinization surgery.
- Indications: Voice feminization surgery, lowering voice pitch in trans men.
Type IV (Elongation/Tensioning):
This procedure elongates or tensions the vocal cords, resulting in a higher voice pitch, and is sometimes used in voice feminization surgery.
- Indications: Voice feminization surgery, raising voice pitch in trans women.
