Phonosurgery & Anti-Aspiration Surgery

The functions of the larynx can be compromised by cancer directed therapy in and around the head and neck area. The voice , specifically can be damaged neurologically as after thyroid surgery and skull base surgery . Based on the understanding of laryngeal neurophysiology , laryngeal framework alteration surgery has been devised in the last two decades by Isshikki and other co workers . These have been named thyroplasty surgeries and range from Type 1 medialisation thyroplasty with /without arytenoid adduction technique to other forms that address other voice deficits. Phonosurgery also includes surgical attempts at cord lateralization to achieve adequate airway owing to the medialized position of a denervated cord. These lateralization procedures can be done transorally through a laryngoscope (laser arytenoidectomy , suture laterofixation ) or can be undertaken by external approach (woodman’s procedure). In addition there are other adjunctive surgeries that can be performed on the larynx to prevent troublesome tracheobronchial aspiration that is associated with resections in the area of the base tongue-vallecula or in the region of the supra glottis . These anti-aspiration techniques range from simplistic laryngeal suspension wherein the larynx is elevated into a position that reduces the distance between the base tongue and the arytenoids . This position is maintained by laryngeal suspension and thyro-mandibular pexy , Needless to say , all these patients undergoing the phonosurgery/airway channelization/anti-aspiration surgeries require intensive rehabilitation of a speech and swallowing rehabilitation expert .