Surgery to Improve the Voice

Surgery performed to alter the voice is called phonosurgery. Dr Vokes is experienced in all of the four major types of phonosurgery.

Endoscopic Phonomicrosurgery (Microlaryngoscopy)

Endoscopic phonomicrosurgery (EP) is surgery performed through a surgical instrument called a laryngoscope that is placed through the mouth to expose the vocal folds. A microscope is used to visualize the vocal folds. Using this technique, vocal fold lesions (such as cysts, polyps, papilloma, nodules or cancer) are removed without making any external incisions.

Laryngeal Framework Surgery

Laryngeal framework surgery (LFS) is surgery performed through an incision in the skin in the front of the neck over the larynx. It involves making alterations  to the cartilaginous framework of the larynx.

The most common procedure in this category is a Medialisation Thyroplasty (also called Type I Thyroplasty), that repositions an immobile or paralysed vocal fold to improve the voice.

In some cases, a Medialisation Thyroplasty is combined with an Arytenoid Adduction, a procedure to reposition the arytenoid cartilage (the back part of the vocal fold) with a suture to further improve voice quality.

Injection Laryngoplasty

Injection laryngoplasty (IL) is surgery to augment (or bulk up) the vocal folds with a filler substance. Dr Vokes prefers to use either Restylane (Hyaluronic Acid) or Restylane Perlane (Hyaluronic Acid) for tempororay augmentation, or Radiesse (Calcium Hydroxylapatite) for longer lasting augmentation. This technique is used to treat vocal fold paralysis, vocal fold paresis (weakness), vocal fold atrophy/bowing (thinning).

In some cases other substances are injected into the vocal folds, such as Botulinum Toxin (Botox), steroids or antiviral medictions.

Laryngeal Reinnervation

Laryngeal reinnervation (LR)  is a technique to improve the voice in people with a paralysed vocal fold. In this procedure, one of the nerves from the ansa cervicalis (a collection of nerves that supplies the strap muscles of the neck) is connected to the main nerve to the larynx (the recurrent laryngeal nerve). This results in new nerve signals passing into the vocal fold.

Dr David E. Vokes