Phonomicrosurgery is a term that describes the use of a surgical microscope while operating on the vocal folds. The vocal folds have a five cell surface layer called the epithelium. Beneath this is a 1 mm layer called the superficial lamina propria, which has the consistency of jelly. This is the critical layer at providing surface pliability to the vocal folds and allowing us to obtain normal voice. Techniques of phonomicrosurgery are typically employed for removal of vocal fold nodules, cysts and polyps. In this setting a very small incision is made in the vocal fold, which is typically 3-5 mm in length. As the epithelium is lifted up the underlying abnormality is carefully dissected from the normal superficial lamina propria beneath. The lesion is then removed with what is termed a subepithelial technique. This creates maximal preservation of the overlying epithelium and minimal disruption to the underlying superficial lamina propria. This technique allows for maximal restoration of the pliability and closure of the vocal folds. Such technique has been employed for a countless number of professional voice users who have achieved normal voice outcomes and revitalised their careers. At times this technique can also be used in salvage surgery. There are times when Dr Broadhurst has a patient referred from an outside institution following vocal cord surgery that had a suboptimal outcome. In this setting sometimes scar has been generated by the surgeon or part of the lesion has been left behind. These techniques can allow Dr Broadhurst to further improve the vocal cord closure and surface pliability, improving the voice.
It is essential that all these patients have a very involved speech therapist for both before and after surgery. After surgery there is a six-week voice rehabilitation period that greatly improves the outcome when compared to surgery alone. Dr Broadhurst will not perform surgery on patients who cannot undergo the appropriate voice rehabilitation following surgery.
Following surgery there is an absolute voice rest period of between 1-2 weeks, determined on a case-by-case basis by Dr Broadhurst. Following the resumption of voice use there will be a carefully guided protocol overseen by both Dr Broadhurst and the speech therapist. By six weeks the majority of patients are back at full voice use.
