What is micro-laryngeal surgery?
Micro-laryngeal surgery refers to microscopic surgery of the vocal folds or other parts of the voice box.
How is micro-laryngeal surgery going to help me?
There are a number of situations in which micro-laryngeal surgery may be helpful or necessary. These include:
- When a lesion such as a vocal fold polyp is causing hoarseness and requires removal. Such lesions can interfere with normal vibration of the vocal folds or even prevent the vocal folds closing during voicing. Non-surgical treatment is usually tried first as it may improve the voice sufficiently or even make the lesion resolve. The likelihood of this can often be assessed from the appearance of the lesion. In addition to improving voice, surgery may be needed to confirm the diagnosis, if this is in doubt.
- Removal of a lesion that is increasing in size, or has recurred after previous surgery, such as a respiratory papilloma or a contact granuloma.
- Biopsy of a lesion suspicious for malignancy or of uncertain behavior. Biopsy refers to removal of the whole lesion (excisional biopsy) where possible, or part of the lesion to confirm the diagnosis. Not all lesions need biopsy, and the probability of malignancy is assessed during diagnostic laryngoscopy in the clinic, often with the help of video-stroboscopy.
- Complete removal of a lesion confirmed to be an early cancer. Voice preserving surgical techniques are used wherever possible.
- For a more specialized procedure, for example when there is narrowing in the voice box resulting in breathing difficulty. Examples are paralysis of both vocal folds (bilateral vocal fold paralysis), webbing or scarring between the vocal folds, and stenosis or narrowing for other reasons.
Pictorial Examples of micro-laryngeal surgery
What happens during micro-laryngeal surgery?
Surgery is carried out using special instruments passed through the mouth to the voice box. The voice box is accessed using a specially shaped metal tube known as a laryngoscope. The laryngoscope is passed through the mouth without the need to make any cuts in the skin. An operating microscope or an endoscope is used to provide a magnified view of the area requiring surgery. Fine miniature instruments and sometimes a laser is used to operate on the voice box. The procedure is performed under general anesthesia. Very often it is possible to go home the same day as the operation, although an overnight stay may be recommended.
What are the risks?
Micro-laryngoscopy is usually very safe. However, there are potential risks which patients undergoing micro-laryngeal surgery should be aware of. These include:
- The risk of undergoing general anesthesia. General anesthesia is safe for most patients, but your personal risk will need to be assessed before undergoing surgery.
- Throat pain. This is common but usually mild and resolves within a few days.
- Numbness of the tongue. This can occur due to pressure from the laryngoscope on the tongue. It usually resolves within a day or two if it occurs.
- Stiff neck. This may occur particularly if you have a history of neck problems. These should be discussed before surgery.
- Injury to the teeth or soft tissues of the mouth and throat. Precautions are taken to protect these tissues and injury is rare.
- Weakness of the tongue and loss of taste. Both are rare.
- Persistent hoarseness. This can occur due to scarring and can be minimized by following careful post-operative instructions.
- Recurrence of the lesion. This depends very much on the type of lesion being dealt with. The likelihood of recurrence and strategies to reduce its risk require discussion on an individualized basis.
Risks vary according to the type of lesion and nature of surgery, and more in-depth discussion is carried out before surgery.
Are there alternatives to micro-laryngeal surgery?
Certain benign (non-cancerous) lesions such as a polyp or nodule can respond to non-surgical treatment. Usually a cyst that is within the vocal fold (in contrast to a polyp or nodule which is on the surface of the vocal fold) will require surgical treatment. However even with a cyst, correcting other factors contributing to hoarseness can sometimes result in voice improvement. Non-surgical treatment may include voice rest, speech therapy, lifestyle changes, and sometimes medication.
In selected situations, a procedure might be recommended under local anesthesia rather than general anesthesia. Examples of this include if a simple biopsy is required, if a lesion can be treated with steroid injection, if an injection is needed to treat a paralyzed vocal fold, or if botulinum toxin injection is required for example in spasmodic dysphonia.
When precise removal of a lesion is required, this is best performed under general anesthesia using micro-laryngeal surgery.
How should I care for my voice after micro-laryngeal surgery?
Looking after your voice carefully is the key to a good outcome following micro-laryngeal surgery. A tailored program of voice rest followed by speech therapy guided voice use is often prescribed. In addition, actions that may add strain to or traumatize the vocal folds such as effortful whispering, throat clearing and coughing must be avoided. Back flow of stomach contents (gastro esophageal reflux) should be controlled through dietary measures and medication where necessary. Occasionally medications like antibiotics and steroids are prescribed to promote healing.
What we can offer at David Lau ENT Centre
Dr Lau is skilled in the art of micro-laryngeal surgery. He is also one of a small handful of surgeons in Singapore skilled at laser surgery of the voice box. He runs courses and is invited to teach regionally on this subject.
“I emphasize careful diagnosis, and guiding patients through the best treatment path, be it surgical or non-surgical. I also emphasize identifying and managing root causes underlying the voice problem, so that we get the best results from surgery if this is needed. I have experience and success in managing certain difficult laryngeal conditions such as early laryngeal cancer, recurrent respiratory papilloma, contact granuloma, and bilateral vocal fold paralysis.”