Endolaryngeal phonosurgery

Abstract

Phonosurgery is any surgery designed primarily for the improvement or restoration of voice. Phonosurgery is therefore not restricted to one or more surgical techniques but is defined by its intended functional goal. A prerequisite for phonosurgery is the adequate diagnosis and documentation of the disordered voice. As the pathogenesis of voice disorders is usually multidimensional phonosurgery may form only a part of the holistic treatment of voice disorders, in partnership with various nonsurgical methods. Phonosurgery should not focus on the appearance of the vocal folds but, rather should aim for an improvement in voice, adapted to the individual request and needs of the patient. Vocal fold surgery is a surgical procedure performed directly on the vocal folds with the aim of improving the vibratory movement and restoration of the normal mucosal wave, or correction of vocal fold position and/or tension. The basic principle of vocal fold surgery is to maintain or improve the functional structure of the vocal fold by respecting its layered structure. This is achieved by means of minimal tissue excision, minimal disruption of the superficial layer of the lamina propria and preservation of the epithelium, especially at the vibrating edge. This can be accomplished using the microflap technique which has completely replaced the resection of the epithelium previously called stripping or decortication which now better is termed subepithelial chordectomy. © Springer-Verlag Berlin Heidelberg 2010.