Laryngoplasty - surgical treatment for weak voices and paralyzed vocal cords

Laryngoplasty - surgical treatment for weak voices and paralyzed vocal cords

Figure 1: Example of severe vocal cord bowing resulting in incomplete closure of the vocal cords.

Figure 2: Diagram illustrating the placement of an implant in medialization laryngoplasty procedure. The implant pushes the vocal cord closer to the midline, so the other vocal cord may better meet it.

Laryngoplasty is a term used to describe a set of different procedures designed to alter the voice box in order to change or improve the voice. The concept of laryngoplasty has been around for decades, but the techniques have only been perfected in the last 10-20 years. Improvements in technology and methods have allowed laryngoplasty to become less complicated and more reliable. Today, laryngoplasty is used relatively commonly to help patients with certain types of voice disorders.

What types of voice disorders may benefit from laryngoplasty?

The most common reason for performing laryngoplasty is for weak or paralyzed vocal cords. Such patients have weak or breathy voices, and may have trouble swallowing. Laryngoplasty, while it does not restore function to the vocal cords, repositions them to allow the voice to return.

Another common reason for performing laryngoplasty is to restore bulk to thin or bowed vocal cords. Patients with bowed vocal cords are typically older individuals with weak voices. They may have trouble speaking in a noisy environment or may tire after speaking awhile.

Laryngoplasty may also be used in a number of special situations that your doctor may discuss with you. These may include problems such as spasmodic dysphonia, vocal cord scarring, or vocal cord fixation.

Are there different types of laryngoplasty?

Yes. There are actually many different techniques that are designed to treat specific problems. However, there are two basic categories of procedures designed to treat the most common problem (inability of the vocal cords to meet fully in the midline—see Figure 1). These are medialization laryngoplasty and injection augmentation laryngoplasty.

Medialization laryngoplasty is a procedure designed to “crowd” the vocal cords together by placing pieces of surgical grade plastic or other material deep to the vocal cords (see Figure 2). This technique provides the best results, since it allows the surgeon to “fine-tune” the voice during the operation. This procedure is done through a small incision in the neck while the patient is sedated in the operating room.

Injection augmentation laryngoplasty is done while the patient is fully asleep in the operating room. The procedure involves injecting a material deep to the vocal cords using special instrumentation. Typically, fat is used. The fat is obtained from the patient’s belly using a liposuction device. While this procedure is technically easier, the surgeon does not have the ability to “fine-tune” the voice, as the patient cannot respond to commands during the procedure. Additionally, the body absorbs much of the fat within a year of the procedure, so this procedure may need to be repeated.

What is arytenoid adduction?

Arytenoid adduction is a separate procedure that is often combined with a medialization laryngoplasty, and is most useful in patients with paralyzed vocal cords. This procedure is technically more complicated than medialization laryngoplasty, but significantly enhances results. It is necessary in paralysis because medialization laryngoplasty alone does not close the back portion of the vocal cord opening.

What is the recovery time from these procedures?

Generally, laryngoplasty is an outpatient procedure that requires minimal recovery time. With medialization laryngoplasty, patients may return to work as soon as 2-3 days after the procedure. Soreness in the neck may last for a week, and the incision may take up to two weeks to heal. The voice may be more hoarse for a period of up to a few months before all the swelling in the vocal cords resolves. However, most of the swelling resolves within two weeks. With injection augmentation laryngoplasty, the recovery time is much shorter. There is almost no pain. However, the patient may be hoarse for a long time after the procedure (up to several months) because of the nature of the procedure.

Will my insurance cover the procedure?

In most cases, insurance companies will cover the procedure if it is medically indicated. The amount of coverage, however, may vary with your individual plan.