Surgery in the operating room is, at times, the solution to a medical problem. The doctors at The Voice Clinic of Indiana have specific expertise in surgical solutions to voice, swallowing, and airway disorders. While a vast array of surgical procedures are performed by the surgeons at our center, the following procedures highlight some of the potential advantages to discussing options with our team:
Voice Restoration Surgery for Glottal Incompetence
Glottal incompetence is the result of incomplete closure of the vocal cords for a variety of reasons (bilateral vocal cord weakness (paresis), vocal cord bowing, or unilateral vocal cord weakness (paresis) or paralysis) and leads to a weak voice and cough, as well as trouble swallowing (dysphagia). Surgery to improve these symptoms through a medialization thyroplasty can be the permanent solution by manipulating the laryngeal framework. Patients under conscious sedation receive a carefully sculpted implant to move the abnormal vocal cord(s) to a more favorable position. To maximize the vocal outcome, extensive expertise allows for surgeons to tune the voice during the surgery by careful adjustment of the implant as the patient vocalizes.
Benign lesions of the vocal cords, including nodules (or fibrovascular changes), polyps, cysts, and other growths often have profound effects on patients’ voices. Phonomicrosurgery includes careful endoscopic resection, maximal soft-tissue preservation, and, sometimes, vocal reconstruction under an operating microscope with the goal of voice restoration. Our doctors have specific training and expertise in performing this delicate and nuanced surgery to maximize vocal outcomes. In addition, our surgeons have extensive experience with the professional voice users who so often develop these problems, including singers, lecturers, teachers, ministers, lawyers, and executives. Whether a professional user or not, voice outcome is paramount for such procedures and will be a priority of our surgeons.
Minimally-Invasive, Endoscopic Surgery
The field of laryngology has expanded with the use techniques and technologies aimed at treating patients in a minimally-invasive way. Voice, swallowing, and airway disorders are often amenable to endoscopic surgery by well-trained surgeons. The following surgical procedures are routinely performed for patients endoscopically, meaning that there is often less pain postoperatively and, often, the ability to go home the day of surgery:
- Endoscopic Zenker’s Diverticulotomy: Resolves swallowing problems related to Zenker’s, or hypopharyngeal, diverticulaEndoscopic
- Voice Restoration Surgery: Allow for restoration of a damaged or abnormal vocal cord to improve patient voice
- Endoscopic Airway Stenosis Management: Allows for immediate relief from breathing difficulties related to subglottic and/or tracheal stenosis (or narrowing)
- Phonomicrosurgery: see above
- Endoscopic Photoangiolytic Laser Surgery: (see below)
Photoangiolytic Laser Surgery
Abnormal growths in the voice box (larynx), including recurrent respiratory papillomatosis, vascular abnormalities of the vocal cords, pre-cancerous lesions (dysplasia), and cancer have abnormal blood vessel formation that contribute to growth. Many surgeons use cold instruments or non-photoangiolytic (such as the carbon dioxide) lasers to destroy the disease; however, such lasers often create collateral tissue damage that can cause scarring, and permanently destroy the delicate vocal cord microstructure critical for voice production. The doctors at The Voice Clinic of Indiana utilize photoangiolytic lasers, which utilize beneficial laser-tissue interactivity to ablate abnormal tissue, target the underlying blood supply to prevent regrowth, and minimize collateral tissue damage. Technical experience with this technology is vital to achieving maximal eradication of disease and preservation of voice producing tissues.
Voice Preserving Surgery for Cancer
Cancer of the voice box (larynx), particular early laryngeal cancer, is a particular area of expertise for the doctors at The Voice Clinic of Indiana. Laryngologists are uniquely suited for treatment of laryngeal cancer, as they are experts in cancer, voice, and swallowing. While radical surgery or non-surgical treatment through radiation or chemoradiation may be best for a particular patient, our doctors may be able to offer surgery that, not only has the primary goal of curing the cancer, but also the goal of maximal preservation of tissues to optimize voice and swallowing outcomes. Such a voice and larynx preservation approach requires a detailed patient assessment, but may help patients avoid both the short-term and long-term negative sequelae of radiation, chemoradiation, and/or total laryngectomy.
Traditional Sleep Surgery for Obstructive Sleep Apnea
Obstructive sleep apnea occurs when the throat collapses during sleep and causes frequent pauses in breathing and low oxygen in the blood. This can lead to fatigue, daytime sleepiness, cognitive problems, cardiovascular disease, metabolic problems, respiratory failure, and heart failure. As a specialist in surgical procedures for breathing, Dr. Parker offers a number of surgical and non-surgical solutions for patients with obstructive sleep apnea. Nasal surgery can be very beneficial to patients with sleep apnea because restricted breathing through the nose makes sleep apnea worse. Septoplasty, turbinoplasty, and functional rhinoplasty are all options depending on patient-specific anatomic problems in the nose. Surgery to open the throat is often suggested for patients with sleep apnea since the throat is the primary site of the problem, but there are a number of surgical procedures that can be chosen. Sleep endoscopy (see “Evaluation Techniques” under “What We Do”) allows Dr. Parker to choose the most appropriate surgical option. When the upper throat (palatal and tonsillar region) needs to be addressed, procedures such as expansion pharyngoplasty, transpalatal pharyngoplasty, uvulopalatopharyngoplasty (UPPP), tonsillectomy, or other procedures may be offered. When the lower throat (tongue base and epiglottic region) needs to be addressed, hyoid myotomy with suspension, tongue base suspension, genioglossus advancement, radiofrequency treatment of the tongue base, or other procedures may be offered. Some patients require several of the above to achieve cure.
SleepIndy.com has more info on snoring and sleep apnea!
Upper Airway Stimulation for Obstructive Sleep Apnea
In addition to the above procedures for obstructive sleep apnea, Dr. Parker offers the latest in upper airway stimulation for sleep apnea. The Inspire device is an implantable stimulator to the nerve controlling the tongue only offered in select centers throughout the Midwest. Similar to a pacemaker, the device detects when a patient breathes in during sleep and opens the throat to eliminate the obstruction and sleep pauses.Click Here to Learn More about Upper Airway Stimulation