A study of phonosurgeries in vocal dysfunction.

Praveen Kumar, M (2008) A study of phonosurgeries in vocal dysfunction. Masters thesis, Madras Medical College, Chennai.


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Phonosurgery essentially is surgery defined to improve or restore voice. To accomplish such a goal, it is often necessary to remove diseased tissues, but eradication of diseases alone is not a sufficient measure of success in phonosurgery. Phonosurgery must be distinguished from conservation laryngeal surgery where the primary aim is eradication of the cancer and voice restoration is a secondary - albeit important - consideration. Dysphonia is the presenting symptom of the phonosurgical patient. The pathologic condition may include various benign vocal fold lesions or diseases affecting the neuromuscular function of the larynx. Dysphonia may result also from the normal aging process, excessive use and vocal abuse. There are many surgical approaches in phonosurgery and techniques continue to evolve. In this study, phonomicrosurgery and medialization laryngoplasty using Gore-Tex are described and their outcome analysed. Although surgical technique is an important determinant of outcome, diagnostic assessment, and surgical indication desire equal attention. It is always necessary to perform a comprehensive voice evaluation, identify the pathologic condition and recognize the appropriate surgical candidate before surgery. Excellent techniques cannot offset the damage done when surgery is performed on the wrong patient or for a nonsurgical problem. The team consists of a laryngologist and a speech pathologist (or phoniatrician) who are knowledgeable about voice production & pathology. Careful assessment should be done preoperatively to describe and localize the pathological condition. This is essential to treatment planning. Normal voice production requires a timely tuned neuromuscular system and mechanical integrity of the vocal folds. Some dysphonia can be corrected with voice therapy. However, when there is structural abnormality or irreversible neuromuscular damage, phonosurgical intervention is indicated. Phonosurgery should correct the mechanical problem without producing substantial secondary problem. Avoidance of secondary intention healing in the membranous vocal fold and appreciation of the histoarchitecture of the vocal fold will help the phonosurgeon avoid disastrous result. Vocal fold paralysis may be treated by voice therapy, implant, injection, framework surgery, and restoration. The results depend on the technique, materials and physiological and psychological status of the patient. In this study of phonosurgeries in vocal dysfunction, the patients who failed conservative therapy are categorized based on their lesions and the outcomes of various phonosurgical techniques (including phonomicrosurgery and medialization laryngoplasty) are analysed. The present study on phonosurgery concludes •Vocal polyp is the commonest benign lesion of the vocal cord that constitutes 40% in our study population. •21-50 years is the commonest age group affected with 74% of the patients fall in this age group. Males are affected more than the females. •Proper investigation of voice & larynx provides the exact pathological nature of the lesion and determines the timing of surgical intervention. •Thyroidectomy surgery is the common etiological factor in recurrent laryngeal nerve paralysis causing unilateral vocal cord palsy. •Out study concludes that successful phonomicrosurgical resection of most commonly encountered lesions can be achieved and 90% of the patients had good outcome. •The success reported herein is the result of improvement in our understanding of the microlayered structure of the vocal folds underlying the vibration and availability of phonomicrosurgical instruments that helps in preserving the layered microstructure of vocal fold. •Most of the patients who underwent medialization laryngoplasty using Gore-Tex also had good outcome at the end of the voice therapy. Only one patient had fair outcome due to inadequate medialization of the vocal cord. •The advantages of Gore-Tex include ease of handling, ease of placement, can be easily adjustable, enhances the speed of surgery and is biocompatible. •No major complications encountered in our study on phonosurgeries. •A team approach including good vocal rehabilitation is of paramount important in obtaining satisfactory outcomes in phonosurgery. The patient and the surgeon must approach phonosurgery collaboratively so that there is mutual responsibility for the decision to operate.

Item Type: Thesis (Masters)
Uncontrolled Keywords: vocal dysfunction; phonosurgery; Dysphonia
Subjects: MEDICAL > Otorhinolaryngology
Depositing User: Devi S
Date Deposited: 03 Jul 2017 12:07
Last Modified: 03 Jul 2017 12:07
URI: http://repository-tnmgrmu.ac.in/id/eprint/853

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