Progress in Laryngeal Framework Surgery

Abstract

This paper reviews progress in laryngeal framework surgery since it was first reported about 25 years ago. The success of this type of surgery requires both a basic knowledge of the physiology of phonation, in order to make decisions about the surgical procedure, and surgical skill, in order to accomplish the intended procedure successfully. The main reason for hoarseness is imperfect closure of the glottis, but the second most important reason for hoarseness, increased stiffness of the vocal fold, cannot be corrected by mere medialization of the vocal fold. Laryngeal framework surgery is different in concept from conventional surgery, which is intended to remove the lesion. Controversial points discussed here regarding type I thyroplasty include: (i) whether the cartilage window should be removed; (ii) materials for fixation of the window; and (iii) comparison of type I thyroplasty with arytenoid adduction. A new surgical treatment for spasmodic dysphonia and its results in three patients are described briefly. Surgery for raising the vocal pitch requires further improvement. In the future, laryngeal framework surgery will have wider application in treatment of dysphonias, such as asthenic voice due to atrophy in professional singers or aging, pitch problems in females and gender identity disorder and spasmodic dysphonia.

Medialization thyroplasty: vocal outcome of silicone and titanium implant

“…1 The silicone implant technique according to Isshiki was performed in ten cases. In all procedures, the inner perichondrium was dissected from the inner thyroid cartilage and left intact as suggested by Isshiki [7,8]. The cartilage window was removed by drilling when using the TVFMI.…”

“…Isshiki [7,8] thoroughly and systematically described the technique of medialization thyroplasty with several modifications to optimize it. A major part of the studies about medialization thyroplasty reported about the use of a silicone implant, resulting in good functional outcome [3][4][5]9].…”

Adenoviral GDNF gene transfer enhances neurofunctional recovery after recurrent laryngeal nerve injury

“…However, these only achieve vocal fold medialization by static changes in vocal fold tissue or the laryngeal framework, and such deficits can never be neurologically restored. 1 Voice therapy is effective only for mild cases and reinnervation procedures have been attempted in very few cases. [2][3][4] Reinnervation procedures (neural anastomosis, nerve graft, etc.)…”

Cirurgia para diminuir a freqüência fundamental da voz - tireoplastia tipo III de Isshiki

“…TÉCNICA CIRÚRGICA Segundo Isshiki 4,7,8,10 , as cirurgias do arcabouço laríngeo classificam-se em quatro tipos de tireoplastias, quais sejam: 1) tipo I, para medialização da prega vocal promovendo melhor fechamento glótico; 2) tipo II, para lateralização reduzindo a resistência glótica;…”