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LEMG | Phonomicrosurgery |Laryngeal Framework Surgery and Augmentation

Key Glossary Terms

Laryngeal Framework Surgery
Surgical modification of the cartilage framework of the voice box so vocal folds can close better or have more tension, which allows vocal folds to vibrate better for sound production

Laryngeal Framework
Cartilages of voice box: thyroid cartilage, left and right arytenoid cartilages, cricothyroid cartilage

Types of Laryngeal Framework Surgical Procedures

• Medialization thyroplasty/laryngoplasty (implant medialization)
• Arytenoid repositioning (arytenoid adduction or adduction arytenopexy)
• Crico-thyroid repositioning (approximation or subluxation)

 Glossary

In Brief

Improve vocal fold closure to improve vocal fold vibration = better voice function

Laryngeal framework surgery is one form of phonosurgery wherein a voice surgeon makes changes to the “cartilage framework” of the larynx (voice box). The intent is to improve the position and/or contour of one or both vocal folds so they close better in order to vibrate better during speaking or singing – but without hindering passage of air for breathing.

Other Terminology

Laryngeal framework surgery or laryngoplastic phonosurgery

Voice Box Cartilage and Type of Procedure

• Thyroid cartilage: Medialization thyroplasty/laryngoplasty or implant medialization
• Arytenoid cartilage: Arytenoid adduction, arytenoid arytenopexy
• Cricoid cartilage: Crico-thyroid approximation, crico-thyroid subluxation

Major Advantage
Laryngeal framework surgery is typically done with the patient awake but sedated and not feeling any pain. A major advantage of this is that it allows the voice surgeon to make intraoperative adjustments to achieve optimal vocal fold function and voice. 

Patients
Patients with voice disorders from vocal fold paresis, vocal fold paralysis, or tissue loss – such as might occur after cancer resection – may benefit from laryngeal framework surgery.

Need for Voice Therapy
Some patients who require laryngeal framework surgery also require postsurgical voice therapy to achieve the best result.

Working Philosophy
To improve voice the surgeon must reposition or shape the abnormal vocal fold so that the other, non-involved vocal fold can meet it to reestablish closure for better vibration – but without compromising air passage.

Working Perspective
Increased understanding of voice function and new procedures have allowed laryngeal framework surgery to become an effective treatment option for patients with certain voice disorders that are due to paresis, paralysis, or tissue loss.

Advisory Note

Patient education material presented here does not substitute for medical consultation or examination, nor is this material intended to provide advice on the medical treatment appropriate to any specific circumstances.

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