Laryngeal framework surgery for voice improvement.

Dysphonias resulting from incomplete glottis closure or inadequate vocal fold tension are eligible for phonosurgical correction. Many different phonosurgical techniques have been used for these indications, but the disadvantages associated with augmentation of the vocal folds by means of intracordal injections and the favourable reports concerning laryngeal framework surgery, have lead to a change in treatment policy in many centers. Most phonosurgeons presently advocate laryngeal framework surgery as the first treatment of choice. For correction of incomplete glottis closure usually thyroplasty type 1 and arytenoid adduction techniques are used. For correction of vocal fold tension cricothyroid approximation and thyroplasty type 3 can be used. Often combinations of different techniques are required to achieve the best result. It is therefore essential to perform these procedures under local anaesthesia, so that the voice can be monitored during the surgery and so that the surgery can be tailored to the patient's voice, 119 patients underwent laryngeal framework surgery, 85 of them for correction of incomplete glottis closure, which in 75 patients was due to unilateral vocal fold immobility. The results in this group were good also in long term follow-up. Complications were few and insignificant. For 30 patients, mostly transsexuals, the aim of surgery was to obtain a higher vocal pitch. This was successful in most patients, but 4 patients had cartilage fracture at the time of surgery as a result of the extreme cricothyroid approximation required. In all cases adequate repair could be obtained without further sequellae.