What is phonosurgery?

The term "phonosurgery" refers to any surgical procedure, performed with an aim to improve the voice. It may also be called as "plastic surgery of the vocal cords".

There are different surgical procedures available at the clinic for the treatment of voice disorders. These include laser voice surgery, laryngeal framework surgery and cord medialisation procedures.

Laser voice surgery

The surgery is performed under general anaesthesia and a special rigid endoscope is used to gain access to the area of the vocal cords. The surgeon uses a microscope to view the area of surgery and the operation is carried out using special micro instruments and lasers Vocal cord surgery is a very precise and delicate surgery and there have been many advances in this field over the last few years. The most notable amongst these is the adaptation of surgical lasers for microlaryngeal surgery. Experience gained by leading experts has shown that the CO2 laser is most suited to the needs of phonosurgery.

Our clinic is equipped with the Lumenis CO2 laser, which has the Acuspot , Acublade and Surgitouch flash scanner modes installed in it. Both these features significantly enhance the precision and safety of the laser, thus increasing the effectiveness of vocal cord surgery.

Sometimes, it becomes necessary to have a laser with coagulating properties for large lesions. In such cases we have a diode laser which we use in combination with the CO2 laser.

Why CO2 laser?

The CO2 laser has several advantages over traditional "cold" surgical techniques:

	The ability to operate without mechanical movement, thus minimizing the risk of damaging the delicate vocal fold structures
	Microscopic precision with almost no thermal damage to surrounding tissue
	Improved control of bleeding, which gives a clear and dry operating field.
	All surgery is contact less, which in turn has its advantages : - Less trauma to the tissues - this reduces swelling and pain after surgery and thus leads to faster healing. - Surgery is highly sterile and there is no post operative infection.
	A markedly improved success rate of recovering voice with fewer recurrences of benign lesions
	Reduced surgical and hospitalization time.

What is the scope of laser phonosurgery?

Laser phonosurgery is performed with good effect for various laryngeal pathologies. These include:

	Pathological lesions like: - protruding lesions like vocal nodules, polyps, vocal cord cysts, papillomas, angiomatous lesions and Reinke's oedema. - Recessed lesions like sulcus vocalis - Leucoplakia and intramucosal cysts
	Malignancy. Over the years, endoscopic laser microsurgery has shown itself to be an effective treatment for early stages of laryngeal cancer. It can also be used in late stages as part of palliative surgery (debulking)

The CO2 laser is also used for alteration of the pitch of the voice

Vocal Cord Polyp Pre Op. Post Op. Pre Op. Post Op. Vocal Cord Cyst

It must be remembered that laser phonosurgery is only a part of the treatment of a voice disorder. Surgery is necessarily accompanied by voice therapy before or after the procedure and sometimes at both times.

Laryngeal framework surgery:

Thyroplasty: This is a technique where the function of the vocal cords can be modified by changing their position and tension, without actually opening the larynx. There are four types:

Type I: One vocal cord is pushed towards the other cord (medialised), by inserting a graft or implant into the tissue of the vocal fold through the corresponding side of the thyroid cartilage.

Conditions leading to incomplete closure of the vocal cords are the main indications for this kind of a procedure.

Type II: Here, the anterior part of the thyroid cartilage is cut vertically and a silicon implant of suitable size is inserted, so as to move the vocal cords away from each other (lateralization).

This procedure is useful in the treatment of such disorders as spasmodic dysphonias and paralysis of both vocal cords.

Type III and IV thyroplasty are procedures which shorten or lengthen the vocal folds respectively and are used to change the pitch of the voice.

Cord medialisation by injections: The vocal cords can also be brought into contact with each other by injecting various substances into the bulk of the vocal fold. These can be fat, collagen, Teflon paste and Calcium hydroxyl apatite.

The main use of this method is again the treatment of various paralytic conditions of the vocal cords.

Vocal Cord Medialisation Thyroplasty I

Pre Operation

Post Operation

 

Botox injections: The botulinum toxin (Botox) is a powerful paralytic agent, produced in nature by the pathogen of the dreaded botulinism disease. Minute doses of Botox are injected into the vocal cords to treat certain voice disorders like spasmodic dysphonia.