What is phonosurgery?

The term phonosurgery pertains to any surgical procedure performed with the aim of improving quality of the voice. Voice is the result of vibration of two delicate structures: The vocal folds (Figure 1).

In order to produce a good voice several conditions have to be met: The neuromuscular system must work properly, so the vocal folds open when we are breathing, and close when we swallow, cough, clear our throat, make an effort (as when lifting weight), or when we speak or sing. In order to produce voice the vocal folds come together and air passes through them generating vibration (Video 1)

There are many individual anatomical factors and health conditions (Figures 2,3,4,5,6) that affect the mechanical properties of the vocal folds causing vibration impairment. Any change on vibration will produce a change in voice quality. Surgical interventions might be necessary to facilitate flawless vibration.

There is a wide range of surgical techniques, and choosing the best option depends on many variables, such as the cause of the problem, the extent of it, the experience and training of the surgeon, the availability of instrumentation and so on.

The one most commonly used is Phonomicrosurgery: A series of delicate, very precise surgeries, performed under general anesthesia with very small instruments or laser beams through a laryngoscope (a metal tube that goes down the throat, up to the level of the vocal folds), with the aid of a microscope.

In other cases it is necessary to modify the position of the cartilages that constitute the framework where the vocal folds are located so those changes facilitate adequate contact between them in order to facilitate easy vibration and voice quality improvement.

Laryngologists also deal with consequences of trauma of the larynx and the vocal folds.

Figure 1

The vocal folds (Ideal configurations) Courtesy of Instituto de Laringología.

Figure 2

Anatomical factors and health conditions. Papillomas of the vocal folds. Courtesy of Instituto de Laringología.

Figure 3

Anatomical factors and health conditions. Congenital web and vocal fold scars. Courtesy of Instituto de Laringología.

Figure 4

Anatomical factors and health conditions. Sub epithelial cyst. Courtesy of Instituto de Laringología.

Figure 5

Anatomical factors and health conditions. Sulvus-Vocalis. Courtesy of Instituto de Laringología.

Figure 6

Anatomical factors and health conditions. Vocal fold carcinoma. Courtesy of Instituto de Laringología.

Courtesy of Instituto de Laringología