• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.24 no.2
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• pp.102-106
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• 2013

The cure rates for early stage laryngeal cancer are similar between laser cordectomy and radiation therapy. As well as the survival outcome, one of the main measures of success in treatment of early laryngeal cancer is voice outcome. Many studies have demonstrated that laser cordectomy and radiation therapy to be equivalent with regard to vocal outcome, whereas others favor radiation. Although such as somewhat disadvantages of voice outcome, laser cordectomy still remains a valid option. Since the patients who treated with laser may benefit from additional phonosurgery to improve postoperative vocal outcome. In this article, we reviewed the techniques of phonosurgery which can be used for laryngeal reconstruction after laser cordectomy. The indications for using each technique are discussed, with particular attention paid to functional outcomes following these reconstructive efforts.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.24 no.2
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• pp.83-87
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• 2013

The term "phonosurgery," coined in the early 1960s, refers to surgical procedures that maintain, restore, or enhance the human voice. Phonosurgery includes phonomicrosurgery (endoscopic microsurgery of the vocal folds), laryngoplastic phonosurgery (open-neck surgery that restructures the cartilaginous framework of the larynx and the soft tissues), laryngeal injection (injection of medications as well as synthetic and organic biologic substances), and reinnervation of the larynx. Phonomicrosurgery is a means of maximally preserving the layered microstructure of the vocal fold, that is, the epithelium and lamina propria. The purpose of the surgery is usually to improve the vibratory characteristics of the layered microstructure of the vocal folds. Phonomicrosurgery has developed from convergence of microlaryngoscopic surgical technique theory and the mucosal wave theory of laryngeal sound production. Improvements in technology (i.e., laryngoscopes, handled instruments, and lasers), which in part arise from developments in more frequently performed minimally invasive surgical procedures, will probably facilitate the next generation of procedural innovations. The best methods of optimizing phonosurgical outcomes include making an accurate diagnosis, completing a comprehensive voice evaluation, providing sufficient preoperative therapy, carefully selecting patients to undergo phonomicrosurgical procedures, and requiring sufficient postoperative rest and therapy. Phonomicrosurgery will continue to evolve as a result of the interdependent collaboration of surgeons with voice scientists, speech pathologist, and other voice professionals.

• Proceedings of the KSLP Conference
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• 2008.03a
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• pp.32-32
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• 2008

• Korean Journal of Bronchoesophagology
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• v.1 no.1
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• pp.64-68
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• 1995

Vocal folds injury from vocal abuse is important topics of phonosurgery. Recent advances in diagnostic equipment, phonosurgery and speech analysis equipment have provided a lot of Information about fine movement of the vocal folds. However, predicting the reaction of the vocal folds to phonatory trauma remains difficult. The vocal folds need to withstand great vibratory and shearing stress and anchoring fibers of basement membrane Bone play a role in maintaining structural integrity of histologically different epidermis and superficial layer of lamina propria(cover of vocal folds). The purpose of this study is to demonstrate the changes of anchoring fibers in vocal polyp using transmission electron microscope. Various defects were observed : a irregular thickening of basement membrane, a near absence of normal anchoring fiber, a lot of electron dense material in superficial layer of lamina propria, a destruction of hemidesmosome and many vesicles carrying electron dense material In basal keratinocyte. These observations were suggestive of a hyperactivity of basal keratinocyte of vocal folds epithelium in response to vibratory stress.

• 대한미세수술학회:학술대회논문집
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• 1992.11a
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• pp.73-73
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• 1992

• Archives of Reconstructive Microsurgery
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• v.2 no.1
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• pp.62-69
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• 1993

Recently, conservative and bloodless operative procedures have been focused, so that endoscopic laser have been used. However application of endoscopic laser surgery for laryngeal lesion is capable for followings: (1)capability of delivery through an operating microscope, (2) vaporization of ultraspot. $CO_2$ laser which has been used, has limitations for voice improvement because of 700 micron beam spot. KTP-532 laser which is capable of delivery through an operating microscope vapore 200 micron ultraspot has developed and applied to microlaryngeal surgery. We have experienced 60 cases who were contracted with hoarseness(53 cases of benign lesions vocal nodule 13, vocal polyp 13, bilateral diffuse polyposis of vocal cords 11, intracordal cyst 8, vocal papilloma 5, laryngocele 1, laryngeal stenosis 2 and 7 cases of malignant lesions : laryngeal carcinoma stage I and II) since 1991. We operated them with KTP-532 Laserscope(3 Watt/0.05 sec., pulsed or continuous. San Jose, Calif, USA). Forty eigh cases(90.6%) of 53 bengin laryngeal lesions and 4 cases(57.1%) of malignant lesions were significantly improved in their voices. There were a few complications and technical problems, but laser surgery alone had a limitation to eradicate the disease.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1982.05a
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• pp.10.1-10
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• 1982

The use of phonosurgery in the recent development of laryngomicrosurgery has enabled the restoration of a normal voice in respect to functional laryngeal surgery which in Korea in the past limited to simple removal of benign laryngeal tumor such as laryngeal polyp or nodules and cordal injection of $Teflon^{{\circledR}}$ for the treatment of recurrent nerve paralysis under the vision of suspension laryngoscopy. Performance of phonosurgery for the treatment of cord paralysis, mutational dysphonia, vocal cord atrophy, hyperkinetic dysphonia and sulcus vocalis is a happy event in the view point of development of phonosurgery in Korea. In this aspect thyroplasty to change the position and physical characteristics of the cord outside the glottis instead of the direct handling of the vocal cord through direct endoscopy is popular. Among the 4 types of thyroplasty, classified by Insshiki(1974), type I thyroplasty(1ateral compression of vocal cord) and type IV thyroplasty(lengthening of vocal cord) were effective in the treatment of unilateral vocal cord paralysis. Advantages of this operation are the fine adjustment of the degree of lateral compression under local anesthesia according to the phonation of the patient during operation and avoidance of dyspnea and intralaryngeal hemorrhage due to the manipulation outside the internal perichondrium of the thyroid cartilage. We did 7 cases of thyroplasty for the treatment of unilateral vocal cord paralysis in the 7 months from September 1981 to March 1982. Before the operation aerodynamic study, psychoacoustical evaluation, stroboscopy and sound spectrographic analysis were done. Two months after the operation the above procedures were performed again. Results of preoperative and postoperative examination were compared and the following results were obtained. 1) In the aerodynamic study, maximum phonation time increased to 158% of the preoperative value and the phonation quotient and the mean flow rate decreased to 58% and 54% of preoperative values. 2) The degree of hoarseness improved in the psychoacoustical evaluation and the glottic chink during phonation was decreased in the stroboscopic examiantion. 3) In the sound spectrographic analysis, periodicity was much restored and noise distribution decreased especially in the high frequency area.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.7 no.1
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• pp.5-10
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• 1996

From October 1991 to June 1995, 4 medialization thyroplasties and I arytenoid adduction were simultaneously performed with the thyroid surgery when the unilateral recurrent laryngeal nerve was paralyzed before or during thyroidectomy. Four cases were papillary carcinoma with direct invasion to the unilateral recurrent laryngeal nerve, and one case was huge adenomatous goiter and the recurrent laryngeal nerve was incidentaly cut. Hoarseness was present preoperatively with mean duration of 15 months and aspiration was also present in three cases. After phonosurgery, voice was improved in 4 out of 5 cases and aspiration subsided in 2 out of 3 cases. In one case, hoarseness continued after total thyroidectomy and thyroplasty type I and the arytenoid adduction with planned due to posterior glottic gap of 2mm. We suggest that the thyroplasty type I or arytenoid adduction are primary phonosurgical procedures which ran be performed concomitantly with neck surgeries in the patients with paralysis of the unilateral recurrent laryngeal or vagus nerve damage during neck surgeries.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.6 no.1
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• pp.27-38
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• 1995

It is well known that unilateral vocal cord paralysis is a sign of a disease and not a disease entity. In an attempt to evalute incidence of unilateral vocal cord paralysis related to varoius causes and to analyze our treatment results, the records of 210 patients seen at the Department of Otorhinolaryngology, Yongdong Severance Hospital during the 10-year period from March 1985 to March 1995 were reviewed. Fifty-three patients(25.2%) of the 210 patients with unilateral vocal cord paralysis had surgery-related causes, and intubations including tracheostomy was the most common etilogy among them. One hundred and fifty seven cases(74.8%) was not related to surgery and, among these most common cause was idiopathic. Spontaneous recovery took place in 17(8%) patients. Phonosurgery including type Ⅰ thyroplasty(n=16) and arytenoid adduction(n=10) and combination of them(n=3) yielded good results except intrafold teflon injection(n=4). These results of our series were compared to other series reported over the past decades.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.28 no.2
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• pp.131-134
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• 2017

Sulcus vocalis remains a surgical challenge despite many recent advances in laryngomicrosurgeries. We previously reported that 585-nm Pulsed dye laser (PDL) exerts favorable outcome in treatment of sulcus vocalis due to its therapeutic effects of collagen rearrangement and improved wound remodeling. In spite of the usefulness of PDL glottoplasty for treating sulcus vocalis, the device is no more available in the country. It prompted us to focus another angiolytic laser ; 532-nm KTP laser which has similar mechanisms of action and has been used for treatment of other laryngeal lesions elsewhere. Herein, we present a case of sulcus vocalis successfully treated with KTP laser. A patient underwent laryngomicrosurgery with angiolytic KTP laser (KTP glottoplasty) by the same surgical procedure with PDL glottoplasty. After the surgery, the patient presented improved voice outcome in time without complications.