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Vocal Fold Paralysis Treatment

Laryngeal Framework Surgery- Permanent Medialisation (Implant) Surgery

Open Laryngeal Surgery (or laryngeal framework surgery/laryngofissure) is performed through a small external cut to the skin to access the larynx. All these procedures manipulate the vocal folds from the outside. They do not touch the interior of the larynx so trauma to the vocal folds does not occur. If possible a local anaesthetic is used so the surgeon can test the voice during the operation. The laryngeal cartilages can then be manipulated either to widen or to narrow the airway, or to alter the position or tension of one or both vocal folds.  Surgical grade materials such as silastic or goretex are frequently inserted as an implant to maintain the desired improvement.

Indications: This surgery is most often performed to push (medialise) one of the vocal folds towards the midline in the case of a paralysed nerve (recurrent laryngeal nerve palsy). This can occur following surgery to the chest or neck or from a tumour or a mass pressing on the nerve. This nerve has a longer course on the left as it passes from the neck into the chest on that side and is therefore more commonly injured than the right one.

Medialising the paralysed fold allows the functioning one to meet it in the midline and therefore close the “gap” between them.

Occasionally there is a very wide gap at the back of the glottis which will require medialisation of the arytenoid cartilage as well as the vocal fold. A suture is placed to stabilise or pull the cartilage inwards.

This operation is more difficult as it requires rotation of the voice box to access the back of the larynx.

Assessment of the correct position and tension is carried out by inspecting using a fibreoptic telescope.

See also St Vincent's Voice and Swallowing Courses for clinicians.