[Surgical management of voice and speech disoreders in childhood. Phonosurgery].

By phonosurgery is meant the sum total of operative techniques that are aimed primarily or solely at the improvement of voice or speech. The different methods of phonosurgery can be used first of all for reducing or ceasing the pathological change of the voice quality, the dysphony and the rhinophony. The techniques recommended for the improvement in dysphony are: direct surgeries on the vocal cords (extirpation methods, intracordal injections) and indirect interventions affecting the cartilaginous frame of the larynx; some neurosurgical methods (nerve-to-nerve anastomosis) are curiosities and the larynx transplantation may show only the future trends. The surgical correction of the hyperrhinophony due to velopharyngeal insufficiency constitutes the other main group of phonosurgery. The velopharyngoplasty (flap surgery) is the most common technique among them. The author categorizes the surgical indications and methods (mostly concerning children) on the basis of his 38 years experience. Removal of vocal cord nodules was performed in 7% of 1740 children with dysphony. The importance of the complex treatment in these cases (speech therapy, medicines, psychotherapy) is stressed. Endolaryngeal interventions (implantation, cutting of a membrane or scars) may only be considered in children when voice problems exist alone without respiratory difficulties. The author has carried out 1000 velopharyngoplasties because of severe hypernasality with different etiology. Anatomical healing was good in 98% of the cases with no mortality; the hyperrhinophony disappeared in 90% of the patients. The ideal age for operation is 4 1/2-5 years. Team work and a competent postoperative logopedic treatment are essential to obtain good results.