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Phonomicrosurgery (phono + micro + surgery)
Highly specialized surgery to improve voice (phonosurgery) using microsurgical techniques and highly magnified views (microsurgery) in order to provide microscopic detail
Superficial Lamina Propria (“Reinke’s space”)
Top layer of the laminae propria that plays a key role in vocal fold vibration; loosely structured; located just underneath the cell lining (epithelium) covering the vocal fold
How is phonomicrosurgery performed?
Phonomicrosurgery is an extremely complex and precise technique that involves several elements.
Element 1: Voice Box Viewed and Reached Through a Laryngoscope
The phonosurgeon visualizes the larynx (voice box) through a laryngoscope that is gently inserted into the mouth and advanced down the throat to expose the larynx. In addition, surgical instruments reach the vocal folds through this tube.
Element 2: Magnified View of the Vocal Folds Through a Microscope
The vocal folds are viewed through an operating microscope, which provides a clear, magnified image. The magnified image is often displayed on a monitor for unrestricted viewing.
Element 3: Re-Examination of Vocal Folds
Before proceeding, the surgeon re-examines the vocal folds with greater magnification. Careful inspection of the tissues with particular instruments allows a re-assessment of the abnormality of the vocal folds. The purpose is:
- to reconfirm the diagnosis
- to examine the extent of the abnormality
- to find other abnormalities that may have not been identified
Element 4: Microsurgery: Long Instruments Passed Through Laryngoscope
Specialized instruments are then used to perform surgery on the vocal folds under magnified views through a microscope. Precise surgical manipulations remove the abnormalities while preserving normal tissue. This is key to successful treatment of voice disorder and improvement or preservation of voice function.
Element 5: “Cold Steel” Instruments and Lasers
Phonomicrosurgery can be performed with metallic instruments (so called “cold steel”) and/or various lasers (laser beams) that can be adjusted and aimed to cut or vaporize tissue.
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