Professional Voice Surgery
Suspension microlaryngoscopy is the gold standard treatment for a large number of lesions of the voice box. Polyps, cysts, scar tissue, and sometimes nodules can be resected under high power magnification using advanced microsurgical techniques. Specialized techniques of microflap excision minimize surrounding damage to the vocal cords and allow for excellent healing with return of the normal singing or speaking voice. There are minimal complications and little discomfort from the surgery. Voice rest is typically required for less than one week after surgery. Voice therapy with a specialized speech pathologist with either a classical singing or professional voice background is essential both before and after surgery for full recovery with an optimal performing voice.
Vocal Fold Paralysis Surgery
People with a paralyzed vocal cord often have a breathy, weak voice; in addition, they may aspirate - have food or liquid go into the lungs. Vocal Fold medialization surgery can help to close the voice box, provide a stronger, more natural voice, and help prevent aspiration. This can be accomplished by an injection of material into the vocal folds to help push them together. This injection is either performed in the office under topical anesthesia, or in the operating room. Another procedure requires a small incision over the Adam's apple and the placement of a small implant to push the paralyzed vocal fold toward the midline. Both are short surgeries, easily tolerated, and often with a great result.
Velopharyngeal Insufficiency (VPI)
Velopharyngeal insufficiency involves an improper closing of the velopharyngeal sphincter, the soft palate muscle, when speaking, producing a nasal quality to the voice and a snorting sound during the pronunciation of certain letters.
This condition may be caused by a cleft palate, improper tonsil or adenoid surgery or nerve or muscle disease. Patients with this condition often experience a speech impediment or changes in their speaking pattern as the main symptom.
Most patients can fully recovery from this condition through a combination of surgery and speech therapy. There are several procedures that can be used to correct this condition, depending on each patient’s individual case. Some of these procedures may include:
- Pharyngeal flap procedure – moves the skin flap from the pharynx to the soft palate
- Pharyngoplasty – lengthens the soft palate with skin flaps
- Augmentation pharyngoplasty – uses an implant to enlarge the pharyngeal wall and narrow the velopharyngeal opening
- Velopharyngeal sphincter reconstruction
Your doctor will decide which treatment is best for you after a thorough evaluation of your condition.
Surgery for the Aging Voice
As we age, so do our vocal folds. They become weak, atrophy, and as a result, vocal quality deteriorates. In addition, constant overuse, abuse, and misuse, especially seen in voice professionals, speakers, and older people can lead to a decreased vocal quality. For the rest of our body, plastic cosmetic surgery can help restore a natural, youthful appearance. Now there is a way to help restore our voices to a more natural, youthful, relaxed quality. The procedure involves an injection of implant material into the lateral part of the vocal cord. This helps add increased substance to the vocal cord and diminishes the effort needed to obtain vocal fold closure and thus voice. This is performed in the office under topical anesthesia, or in the hospital setting.
Microlaryngoscopy is a procedure that means the vocal folds are looked at in great detail with magnification. The magnification may be with a microscope, endoscope or by video enlargement. It is often accompanied by some additional procedure such as removal of a mass, swelling or tumor. Long delicate instruments or a laser may be utilized. It is sometimes performed in the office, though more typically it is performed in the operating room.
Vocal Fold Injection Medialization
Vocal fold injection is used to treat unilateral vocal fold paralysis by injecting material into the paralyzed vocal fold. This pushes the paralyzed fold to the middle so that when the normal fold closes there is no gap. For this procedure the patient is put to sleep with a general anesthetic and a special scope is put into the throat so that the injection can be performed. There are several things that can be used for vocal fold injections, these include your own fat or synthetic materials. Some injections can be performed with local anesthesia.
A surgical technique designed to improve the voice by altering the cartilages of the larynx (the voice box), which houses the vocal folds (the vocal cords) in order to change the position or length of the vocal folds.
Advanced techniques at surgical resection of early laryngeal cancer allow for improved voice results with excellent survival rates. Using the new KTP laser allows for resection of the tumor and removal of the blood supply to the tumor. This results in a more complete resection of the lesion and allows sparing of surrounding normal tissue. The use of surgery for early voice box tumors spares the need for radiation therapy. Continued surveillance is easily performed in the office, and small areas of abnormal tissue can even be removed in the office using the KTP laser with topical anesthesia.
Digital Video stroboscopy is available in our clinic for the analysis of vocal complaints. This is the gold standard tool in diagnosing disorders of the voice. Specialized training allows for the precise interpretation of this tool. This advanced laryngeal imaging system utilizes endoscopic visualization (use of flexible and rigid telescopes to look at the voicebox) and stroboscopy (high speed flash lamp) to generate high-quality, detailed video and still images of the larynx. Based on the diagnosis, medications, speech therapy, or surgical procedures may be recommended by the physician.
Fiberoptic Endoscopic Evaluation of Swallowing and Sensory Testing
Patients with swallowing disorders can have an objective test that examines their ability to swallow solid and liquid food materials. During this examination, compensatory techniques can be taught and demonstrated to help improve swallow function and help protect the airway. This test is useful in ruling out aspiration, or choking of food or liquid. In addition, this procedure can test the sensation of the voice box, giving added information about the sensory nerves of the voice box. This is done in an office setting with topical anesthesia and does not require the use of X-rays.
TNE (Trans-nasal Esophagoscopy)
TransNasal Esophagoscopy (TNE) is a technique of endoscopically examining the esophagus with an ultra thin flexible endoscope that is passed via the nose into the esophagus. This procedure is done in the office with topical anesthesia. Excellent visualization of the esophagus and stomach is performed with minimal discomfort. A patient can then drive home immediately after with no downtime and no prep needed. This is an excellent screening tool for Barrett's esophagus and cancer of the esophagus.