Laryngeal framework surgery is a procedure that changes the supporting structures of the larynx (voice box) and vocal folds. Commonly, this procedure is done to reposition a paralyzed vocal fold or to bulk up thinning vocal folds to a position that is better for voicing. The procedure described above is known as medialization laryngoplasty. This usually involves placement of a synthetic implant and/or stitches to reposition the vocal folds or cartilages surrounding the voice box. A variety materials are used for laryngeal framework surgery, including but not limited to silicone or Gore-Tex™. You will work with your laryngologist to determine the best material for your voice condition.
Laryngeal Framework Surgery Procedure
Laryngeal framework surgery is mainly performed while the patient is awake, as the voice must be assessed periodically during the surgery to achieve optimal results, but also to maximize safety of the procedure by avoiding general anesthesia. Patients are given local anesthetic (numbing medicine injected into the skin), and a light amount anesthesia through an IV given by an anesthesiologist. Any discomfort is very mild and well tolerated by most patients.
Laryngeal framework surgery usually requires a very small incision through the skin on the front part of the neck over the thyroid cartilage, commonly referred to as the “Adam’s Apple”. The exact size and location of the incision depends on several factors including the type of surgery being performed. The thyroid cartilage/“Adam’s Apple” is then identified and a small hole is created to place an implant. The implant is then placed and the patient is asked to speak at various pitches and volumes. This is a huge advantage to this procedure. Having the patient be able to speak during the procedure helps to fine-tune the implant size and the position of the implant to help improve voice quality
Potential complications of Laryngeal Framework Surgery
With any surgical procedure, there are inherent risks. Patients may experience resultant swelling after any such procedure, and therefore, patients may be observed in the hospital overnight to make sure no issues occur. This is a very rare, but potentially life threatening complication, so every precaution is taken to avoid this. Infection is also something to be considered, as the surgery involves placement of an implant which is a foreign object.
Pros and cons to laryngeal framework surgery
There are many advantages to laryngeal framework surgery. The biggest advantages are the ability to fine-tune the voice while the patient is awake, no general anesthesia, permanent voice improvement, reversibility, and often excellent results. There are, however, disadvantages including but not limited to a neck incision and the need for the patient to be awake and cooperative during the procedure. The procedure is also technically more difficult to perform than some of the other augmentation procedures. In some cases, the implant may need to be revised in the future due to sub-optimal voice result.