Overview | Understanding Phonomicrosurgery | How It’s Done | Indications |
Strategies | The Patient’s Role
Key Glossary Terms
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
When is phonomicrosurgery recommended as treatment for voice disorders?
General Indications
The phonosurgeon, often working in concert with a speech pathologist and/or the voice care team (see Voice Care Team), will recommend phonomicrosurgery to patients with voice disorders caused by:
- a vocal fold abnormality that is unlikely to respond to voice therapy or medical management
- a vocal fold abnormality that has not responded to a trial of voice therapy and/or medical therapy
- a vocal fold abnormality that is “suspicious” for cancer (atypia, early cancer) (For more information, see Laryngeal Atypia and Early Cancer.)
Specific Indications
In combination with medical and voice therapies when necessary, as well as lifestyle changes when applicable, phonomicrosurgery can be effective in treating and improving the voice function of patients with the following voice disorders:
- Vocal Fold Nodules
- Vocal Fold Polyps
- Vocal Fold Cysts
- Vocal Fold Pseudocysts
- Vocal Fold Granulomas
- Vocal Fold Vascular lesions
- Vocal Fold Papillomatosis
- Vocal Fold Atypia or Leukoplakia
- Laryngeal Early cancers
- Vocal Fold Scarring (to some extent)
What are key factors in successful phonomicrosurgery?
Correct Diagnosis is Key
As with any treatment strategy, the most important factor in achieving the best surgical result is in making the proper diagnosis. In some cases, the diagnosis needs to be made by microlaryngoscopy – i.e., while viewing the vocal folds with an operating microscope.
Accurate Delineation of Abnormality and Surrounding Normal Areas
It is also equally important to assess the extent of involvement of surrounding tissue, since preserving normal tissue is critical to adequate healing and the restoration or improvement of voice function.
Surgical Competence and Skills
The experience and skills of the operating surgeon are central to the success of phonomicrosurgery.
Is phonomicrosurgery similar to other types of surgery?
In many ways, the principles of phonomicrosurgery are the same as the basic principles of surgery, but with a higher expectation of precision.
- Adequate exposure: It is important to have adequate exposure (open surgical area) so the tissues can be easily visualized and manipulated.
- Preserve normal tissue: Tissues must be handled gently to minimize damage to normal structures, which should be carefully preserved when removing the abnormal tissue.
- Control of bleeding: Bleeding should be prevented or controlled so that the microscopic structures are easily visualized, facilitating dissection.
- Minimize post-surgical scarring: Post-surgery healing should be facilitated in order to minimize scarring that might be detrimental to voice function.
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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