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Laryngeal framework surgery encompasses a group of procedures that manipulate the supporting structures of the larynx, with the goal of changing vocal fold shape and position. The soft tissues of the larynx, including the vocal folds, are surrounded and supported by a set of cartilages which are generally easy to feel in the neck; they form the “Adam’s apple”. Changes in their shape, position and relationship to one another have an effect on the position of the vocal fold.
Most commonly, an operation is used to reposition a paralyzed vocal fold to a position that is better for voice production. This is known as medialization laryngoplasty. This may involve placement of an implant and/or sutures to readjust the position of laryngeal cartilages. A variety of implantable materials are available for laryngoplasty, including silicone, Gore-Tex™, and a substance called calcium hydroxylapatite. None of these materials has a clear advantage, but there are various considerations in implant selection. The advisability of repositioning certain cartilages (known as arytenoid adduction), and variations in technique, are also debated among laryngologists. These issues should be discussed with your surgeon.
Most laryngeal framework surgery is performed with the patient awake. This is done principally because the voice quality must be assessed periodically during the surgery, but also to maximize safety of the procedure by avoiding general anesthesia. The patient is given local anesthetic, as well as anesthesia via an intravenous line, so that any discomfort experienced is mild. Laryngeal framework surgery is well tolerated by nearly all patients
Laryngoplasty usually requires an incision in the skin of the neck, the size and location of which depends on the type and extent of laryngoplasty being performed. After this incision has been made, the laryngeal cartilages are reached quickly. Once the planned changes have been made, the patient is asked to voice at various pitches and volumes, to help fine-tune the implant size and the position of the arytenoid cartilage. When optimum voice is achieved, the incision is closed.
Because the larynx typically swells after such a procedure, patients are sometimes observed in the hospital overnight to make sure no difficulty breathing develops. This is a very rare but potentially dangerous complication, so every precaution is taken. Infection is also a consideration, as laryngoplasty ususally involves implantation of a foreign substance. In practicality, the main obstacle of the operation lies in obtaining the best voice result. A suboptimal voice result is the most common reason this operation is repeated or revised.
