What is Microlaryngeal Surgery?
Microlaryngeal surgery, or phonomicrosurgery, has been developed since 19th Century as the observation of the larynx through reflecting mirrors began. Laryngeal mirrors (tools with small mirrors attached which are used to see into the larynx through the mouth) provided the most significant part of understanding and treating vocal fold diseases.
Benign vocal fold diseases including vocal nodules, vocal polyp, sulcus vocalis, vocal cyst, and adhesive vocal folds are limited to the lamina propria which affects the movement of epithelium that covers the vocal folds and the mucosa.
Procedure of Microlaryngeal Surgery
Micro laryngeal surgery is the surgery of the voice box with the help of a microscope. The surgical procedures require high expertise in precision and accuracy. It is a complex procedure which must be performed after complete diagnosis of the larynx and sometimes includes the biopsy of the tissues of the region. Usually, any aberration of the voice can be treated by the conservative treatments such as voice exercise and medications. But in certain circumstances, the operative measure of laryngeal surgery is necessary. It is done when if certain lesions such as cysts polyps, granulomas and benign tumors are found over the larynx and requires immediate action to remove them. These lesions or tumors can be formed due to multifarious reasons voice trauma, consistent irritation, vocal overuse, acid reflux, persistent coughing and many more.
Microscopic voice surgery is mainly performed by using an instrument called laryngoscope. It’s an elongated tube which is inserted till the larynx through the mouth. A microscope is being set to get the microscopic picture of the region of the voice box. The whole surgical procedure is performed under the microscope with the help of a group expert surgeons and anesthesiologists. The small, pointed and elongated surgical instruments are inserted to perform inside the larynx. All the instruments with long stems are inserted through the laryngoscope and the surgery is performed with expert hands.
Precautions for the Patient of Microlaryngeal Surgery
During the surgery, the use of general anesthesia is mandatory as the patient must not have any memory of the surgery. After the injection of general anesthesia and its effect, the laryngoscope is inserted and placed over the larynx. Instruments are inserted one after another through the larynx and the operation is performed. In the process, the targeted area must only be cut or removed leaving the rest of the region to be untouched. The majority of the voice surgery is performed in the outpatient and released on the day of the surgery. It usually has a quick recovery time and does not require any hospital stay.
Submucosal infusion technique of Microlaryngeal Surgery
The submucosal infusion is a technique which recovers the voice by separating the mucous membrane with lesion and the lamina propria of the vocal folds and preserving the lamina propria when performing the surgery.
The instruments used are
(1) 2cc Luer-Lock 27G microscopic needle
(2) 1:20000 epineprine with sterile saline
Diagram of submucosal infusion technique
Micro Mini-flap Surgery
As the microstructure of the vocal folds and the process of healing in benign vocal fold diseases, have been demonstrated, studies have proved the significance of preserving the lamina propria of the vocal folds and the importance of vocal rest and rehabilitation (Influence of phonation on basement membrane zone recovery after phonomicrosurgery: a canine model. Annals of Otology, Rhinology & Laryngology 2000;109:658-666 in collaboration with Hyung-tae Kim)As a result of these studies, surgical operations of the vocal folds including the micro mini-flap surgery which can bring the voice to original condition have been developed. Using the micro mini-flap surgery, positive vocal fold surgeries which could not be performed in professional vocalists or singers to be performed.
Microscopic diagram of micro mini-flap surgery