Surgery Flashcards
When is surgery necessary/the best option?
Therapy does not yield the desired results
Therapy cannot yield the desired results
A suspicious lesion, find pathology
Maintain airway
What are the two kinds of procedures one can have?
Office-Based and Operating Room Procedures
What are some benefits of an office-based procedure?
Procedures without general anesthesia Cost-effective Patients typically transport themselves Quicker return to voice use Ability to assess phonation/ glottal competency during procedure
What are some examples of office-based procedures?
Indirect Laryngoscopy Mirror Flexible KTP Laser Injection Laryngosplasty
Botox Injections
What are some cons to office-based procedures?
Tissue can only be manipulated or resected so far
Not an option for more involved cases
Patient comfort
What is an endotracheal tube?
A tube that is placed from the mouth or nose past the vocal folds into the trachea during surgery to ensure airways remain intact.
Describe Microlaryngoscopy.
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
Describe a microflap dissection.
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
What is a recommended surgical option when there is a cyst or polyp on a layer deeper than the superficial lamina propria?
Microflap dissection
Describe Laser laryngoscopy.
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
How long does a laser laryngoscopy take?
30-40 minutes
What is laser laryngoscopy usually used for?
Useful in treating papilloma and vascular lesions and in procedures such as a hemilaryngectomy and cordotomy
What are the pros to laser laryngoscopy?
More precise cut or excision with less burn injury to surrounding tissue
Keeps the surgical field more free of obstruction
What are the cons to laser laryngoscopy?
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
What are the SLP’s roles in voice Surgery?
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
List the surgical options for vocal fold paralysis.
Injection laryngoplasty. (Temporary)
Thyroplasty (Permanent)
True or False. Injection Laryngoplasty can occur in office or in the operating room.
True. But it is much quicker and easier to do in office. Rarely do you need to use the operating room.
What is thyroplasty used for?
People who want a permanent solution for vocal fold paralysis.
What is Unilateral Transverse Cordotomy used for?
Bilateral Abductor vocal fold paralysis; it creates a hole in the vocal folds for respiration.
Describe a Bilateral Transverse Cordotomy.
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
What is a complete cordotomy?
Complete removal of one vocal fold, including the vocalis muscle, that is typically used in treating a localized malignancy
Usually completed with laser laryngoscopy
How many types of phonosurgery classifications are there?
Four Types
Describe Type I phonosurgery.
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.
Describe Type II Phonosurgery.
Type II is lateralization laryngoplasty involving lateralization of thyroid cartilage. The resultant voice is soft and breathy. (Abductor Paralysis)
Describe Type III Phonosurgery.
Type III thyroplasty is anterior-posterior thyroid cartilage shortening that results in a lax VF and results in pitch lowering. (For transgender individuals)
Lateralization vs. Medialization ??
Lateralization is moving something away from the midline.
Medialization is moving something (i.e. VF) towards the midline.
Describe Type IV Phonosurgery.
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.
Functional Voice Exercises are good for which populations?
Hyperfunction Hypofunction Presbylarynges MTD Nodules (Some evidence for neurological)
