Vocal cord surgery
The vocal cords are the site of various benign or malignant pathologies, requiring histological diagnosis and management to improve dysphonia (voice changes) or breathing.
Vocal cord surgery involves suspension laryngoscopy, a variant of panendoscopy in which the surgeon has both hands free to use instruments or a laser to palpate, biopsy or remove a vocal cord mass.
Find out more about vocal cord surgery from Dr Delagranda, ENT and cervico-facial surgeon at La Roche-sur-Yon in the Vendée.
Larynx
The larynx is a complex cartilaginous organ of the respiratory system, located in the neck. It is located both in front of and below the aerodigestive crossroads formed by the pharynx. It is the intermediary between the oropharynx and the trachea. It protects the vocal cords, which are an integral part of this organ. It has three main functions:
- a respiratory function: as an integral part of the respiratory tract, it carries inspired air to the lungs.
- a protective role: as a protector of the lungs, it prevents food and liquids from flooding the lungs during swallowing, by closing as it rises, bringing the vocal cords together and tilting the epiglottis, a soft cartilage at the top. The larynx also protects the vocal cords from external shocks, thanks to a very hard shield-like anterior cartilage called thyroid cartilage.
- a phonatory role: exhaled air, modulated by movements of the laryngeal muscles, causes the vocal cords to vibrate, producing sounds.
Who needs vocal cord surgery?
Adults with persistent voice changes (dysphonia) or shortness of breath (dyspnea).
Causes of dysphonia for adults:
- vocal overwork in voice professionals (teachers, singers, etc.)
- infectious conditions (laryngitis)
- gastric acid reflux
- smoking or drug use
- laryngeal trauma (e.g. combat sports, intubation for general anesthesia)
- severe psychological trauma (often associated with spasmodic dysphonia).
Causes of dysphonia for children:
- an infectious context
- screaming children
- stridor (a high-pitched inspiratory noise), with rare cases requiring laryngoscopy in suspension, but generally involving a part of the larynx other than the vocal cords (the epiglottic folds).
Causes of vocal cord dyspnea for adults :
- malignant or benign obstructive vocal cord tumors
- chronic infectious conditions: laryngeal papillomatosis
- gastric acid reflux
When is vocal cord surgery advisable ?
Suspension laryngoscopy is indicated in cases of:
- suspicion of cancer (persistent unexplained pain, persistent unexplained voice changes, bleeding, involuntary weight loss, anorexia, difficulty swallowing or pain on swallowing)
- Suspicion of benign tumors, cysts, polyps, granulomas, vocal cord nodules with dysphonia (voice changes) or aphonia (loss of voice). Nasofibroscopy in consultation is a screening procedure prior to laryngoscopy in suspension.
- difficulty in breathing due to a mass obstructing the glottis (space between the vocal cords)
- paralysis of one vocal cord to medialize it (bring it closer to the other) or remove part of it in order to breathe (bilateral closure paralysis)
Objectives of vocal cord surgery:
- Determine the appearance and local extension of a vocal cord tumor or mass
- Perform a biopsy
- Remove a vocal cord mass, and more rarely part or all of the vocal cord
- Inject antivirals
The different stages of the intervention
The surgical procedure
Always performed under general anaesthetic, and usually on an outpatient basis, the procedure involves inserting a laryngoscope, a metal device with an open center that illuminates the larynx. The laryngoscope is held in place by a “suspension” placed on the thorax or on a shelf. The suspension frees the surgeon’s 2 hands, enabling him to insert rigid optics with multiple viewing angles (0°,30°,70°) to specify the implantation, the position of the mass and its texture by palpation. A biopsy can be performed, or the mass removed directly, depending on the context, using adapted long instruments, a micro debrideur or a laser.
Post-operative convalescence
The patient returns home on the same day as the operation in the case of outpatient hospitalization, or after a short hospital stay in the case of dyspnea (shortness of breath).
Pain is not significant, but may affect the nape of the neck as the neck is extended during the operation.
A mark may be present on the thorax at the level of the sternum, due to the heavy weight of the suspension; this usually disappears within 24 hours.
It may take longer for the voice to return to normal, with the use of aerosols and speech therapy for several weeks if necessary.
Time off work depends on the pathology concerned and the type of work performed (use of voice).
Post-operative care at home: vocal rest, analgesics, aerosols, anti-inflammatories, anti-reflux depending on etiology.
Scarring: no visible scarring
Complications associated with vocal cord surgery
In addition to the risks inherent in any surgery involving general anesthesia, suspension laryngoscopy presents some minor risks:
- mouth sores, lip pinching
- Abnormal mobility of teeth (the presence of fragile teeth (bridges, implants) should be noted)
- tooth dislocation
More serious or exceptional risks:
- Laryngeal edema (swelling of tissues due to reactive inflammation) with respiratory discomfort
- Pneumothorax
- Burns on the face or in the pharyngolarynx in the event of laser treatment
- Cartilage infection or chondritis in the event of laser treatment
For further explanations, please refer to the ENT College’s explanatory sheet on suspension laryngoscopy:
➔Laryngologie et laryngoscopie
➔Laryngoscopie en suspension chez l’enfant
➔Laryngologie médialisation corde vocale
➔Cordectomie par laser
Frequently asked questions about vocal cord surgery
Here is a selection of questions frequently asked by Dr Delagranda’s patients during consultations for vocal cord surgery in La Roche-sur-Yon.
Is suspension laryngoscopy mandatory?
Yes, in the case of cancer, and recommended if your surgeon suggests it.
Is it very painful?
No, as a rule, it hardly hurts at all.
Can I talk right away?
In most cases, we recommend that you speak as little as possible, and whisper if necessary.
Fees and coverage of the procedure
Suspended laryngoscopy is covered by the French health insurance system. Contact your mutual insurance company to find out whether any extra fees will be covered.
Do you have a question? Need more information?
Dr. Antoine Delagranda is available to answer any questions you may have about vocal cord surgery. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche sur Yon, France
ENT consultation for vocal cord surgery in Vendée
Dr Antoine Delagranda will be happy to answer any questions you may have about vocal cord surgery. Dr Delagranda is a specialist in ENT surgery at the Clinique Saint Charles in La Roche-sur-Yon in the Vendée.