Abstract
Laryngeal framework surgery has been performed on over 100 cases of dysphonia in our hospital for the past 8 years. This paper summarizes surgical knacks for each type of surgery on the basis of clinical experience.
1. Thyroplasty type I.
Difficulty may exist in incising the calcified thyroid cartilage in a window shape. Overcorrection of the paralyzed vocal cord is recommended when the postoperative course is taken into account.
2. Arytenoid adduction
Unilateral vocal cord paralysis with a wide glottal clink is a good indication for arytenoid adduction. Palpation along the cricoid cartilage ridge is the key to locating the cricoarytenoid joint. The knack in preventing complications is not to enter the air-way.
3. Surgeries to change the vocal pitch
Surgery to lower the vocal pitch reduces the A-P distance of the thyroid cartilage, thereby relaxing the vocal cord. “Unilateral shortening first, if insufficient in lowering the pitch, then bilateral procedures” is the policy of surgery. The vocal pitch can be raised either by cricothyroid approximation, chordal injection of steroid or chordal scar formation.
As a future problem, the effect of stiffness and of mobility of the vocal cord mucosa upon the vocal cord vibration should be further assessed.
