Practical Applications of Laryngeal Framework Surgery

Abstract

Phonosurgery is defined by the International Association of Phonosurgery as any type of surgery that is performed with the aim of improving or changing voice or speech. This definition implies that the goal of phonosurgery is to restore function rather than normal anatomy. The subgroup of phonosurgical techniques that demonstrate this concept most clearly is laryngeal framework surgery (LFS), which is based on concepts of the physiology of phonation and laryngeal biomechanics and is by definition a functional type of surgery. One of the important aspects of LFS is that these procedures are performed under local anesthesia to enable intraoperative voice monitoring, which allows the surgeon to fine-tune the voice and thus obtain the best functional result. Another important aspect of LFS is that surgical damage to the vocal folds is avoided by directing the intervention to the cartilaginous structures attached to the vocal folds rather than the vocal folds themselves. By changing the shape or position of some of the laryngeal cartilages and thus providing biomechanical compensation for the phonatory dysfunction, many types of dysphonia can be corrected without jeopardizing the delicate structure of the vocal folds and without inadvertently changing the mass, volume, or stiffness of the vocal folds. Some types of laryngeal framework surgery have already been suggested decades ago. For example, in 1915, Payr [1] described an anteriorly pedicled transverse, U-shaped cartilage flap in the thyroid ala, which was depressed inwardly to medialize the vocal fold. The effect, however, was limited, probably because the anterior pedicle restricted adequate medialization and because fixing the cartilage flap in the desired position proved difficult and uncertain [2]. Despite several other efforts, the concept of LFS remained fragmentary until Isshiki and colleagues [3] presented their innovative ideas