Surgery

Question 1

When is surgery necessary/the best option?

Answer 1

Therapy does not yield the desired results
Therapy cannot yield the desired results
A suspicious lesion, find pathology
Maintain airway

Question 2

What are the two kinds of procedures one can have?

Answer 2

Office-Based and Operating Room Procedures

Question 3

What are some benefits of an office-based procedure?

Answer 3

Procedures without general anesthesia
Cost-effective
Patients typically transport themselves
Quicker return to voice use
Ability to assess phonation/ glottal competency during procedure

Question 4

What are some examples of office-based procedures?

Answer 4

Indirect Laryngoscopy
Mirror
Flexible
 KTP Laser
 Injection Laryngosplasty

Botox Injections

Question 5

What are some cons to office-based procedures?

Answer 5

Tissue can only be manipulated or resected so far
Not an option for more involved cases
Patient comfort

Question 6

What is an endotracheal tube?

Answer 6

A tube that is placed from the mouth or nose past the vocal folds into the trachea during surgery to ensure airways remain intact.

Question 7

Describe Microlaryngoscopy.

Answer 7

Excision of a lesion with suspension, binocular microscope, and forceps (retract) and microscissors (excise)

Nodular lesions or small polypoid lesions

Takes about 10-20 minutes

Question 8

Describe a microflap dissection.

Answer 8

An initial incision on the vocal fold surface, followed by dissection into Reinke’s space to dissect out firm pathology and remove swelling, with the tissue then being draped over itself to heal (excising any excess)

Removal of a larger lesion (polyps, Reinke’s edema, cyst) or submucosal lesion

20-30 minutes

Question 9

What is a recommended surgical option when there is a cyst or polyp on a layer deeper than the superficial lamina propria?

Answer 9

Microflap dissection

Question 10

Describe Laser laryngoscopy.

Answer 10

Focused beam of energy used to burn/ vaporize tissue, with the CO2 laser the most commonly used in laryngeal surgery as the energy is absorbed by water

Question 11

How long does a laser laryngoscopy take?

Answer 11

30-40 minutes

Question 12

What is laser laryngoscopy usually used for?

Answer 12

Useful in treating papilloma and vascular lesions and in procedures such as a hemilaryngectomy and cordotomy

Question 13

What are the pros to laser laryngoscopy?

Answer 13

More precise cut or excision with less burn injury to surrounding tissue
Keeps the surgical field more free of obstruction

Question 14

What are the cons to laser laryngoscopy?

Answer 14

C02 laser can only be delivered to line of sight
Risk of thermal injury or scarring to adjacent tissue
Risk of airway fire (O2)
Increase in cost, personnel, and time

Question 15

What are the SLP’s roles in voice Surgery?

Answer 15

Educate about the need for voice rest

Educate about vocal hygiene and discuss ways of implementing this in patient’s daily life

Voice therapy after surgery as needed

Repeat videostroboscopy to show successive improvements

Question 16

List the surgical options for vocal fold paralysis.

Answer 16

Injection laryngoplasty. (Temporary)

Thyroplasty (Permanent)

Question 17

True or False. Injection Laryngoplasty can occur in office or in the operating room.

Answer 17

True. But it is much quicker and easier to do in office. Rarely do you need to use the operating room.

Question 18

What is thyroplasty used for?

Answer 18

People who want a permanent solution for vocal fold paralysis.

Question 19

What is Unilateral Transverse Cordotomy used for?

Answer 19

Bilateral Abductor vocal fold paralysis; it creates a hole in the vocal folds for respiration.

Question 20

Describe a Bilateral Transverse Cordotomy.

Answer 20

Both vocal folds are divided from the vocal process, allowing for a greater glottal gap while still leaving minimal risk for aspiration and minimal change in voice

Question 21

What is a complete cordotomy?

Answer 21

Complete removal of one vocal fold, including the vocalis muscle, that is typically used in treating a localized malignancy

Usually completed with laser laryngoscopy

Question 22

How many types of phonosurgery classifications are there?

Answer 22

Four Types

Question 23

Describe Type I phonosurgery.

Answer 23

Type I is a form of Medialization Laryngoplasty; could be used with arytenoid adduction. This is just the injection of material to medialize a VF to adduct better with the other VF.

Question 24

Describe Type II Phonosurgery.

Answer 24

Type II is lateralization laryngoplasty involving lateralization of thyroid cartilage. The resultant voice is soft and breathy. (Abductor Paralysis)

Question 25

Describe Type III Phonosurgery.

Answer 25

Type III thyroplasty is anterior-posterior thyroid cartilage shortening that results in a lax VF and results in pitch lowering. (For transgender individuals)

Question 26

Lateralization vs. Medialization ??

Answer 26

Lateralization is moving something away from the midline.

Medialization is moving something (i.e. VF) towards the midline.

Question 27

Describe Type IV Phonosurgery.

Answer 27

Type IV thyroplasty is anterior-posterior elongation by crico thyroid approximation. The cricothyroid approximation results in a longer, thinner VF and a higher pitched voice. This surgery is appropriate for patients undergoing gender reassignment and those with cricothyroid muscle paralysis.

Question 28

Functional Voice Exercises are good for which populations?

Answer 28

Hyperfunction 
Hypofunction 
Presbylarynges
MTD
Nodules
(Some evidence for neurological)