A Voice SLP’s Dream: Stories from the OR


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It’s not often enough that those of us who are voice users or those of us who rehabilitate voice, get to see what our mechanism looks like. Rarer still, is the chance for an SLP to observe in the operating room for a procedure that many clients undergo.

When individuals experience poor glottic closure, it can be from a number of things such as paralysis, disuse atrophy, or presbylaryngus to name a few. This causes the patient to be hoarse, breathy, and soft in volume. A procedure to medialize the vocal folds actually helps them touch during phonation (sound production) and improve overall function. Many times they need voice rehabilitation to help them learn to work with their new and improved hardware.

Here are some photographs (permission obtained from patient and physician) that show the steps to a bilateral TVF medialization laryngoplasty. I hope you enjoy learning about this procedure just as I did while I was there.


This is the view of the surgical site. It is the front of the voice box, or larynx.This is the view of the surgical site. It is the front of the voice box, or larynx.

This is the view of the surgical site. It is the front of the voice box, or larynx.


Next, an anterior incision was made across the neck and the tissue was pulled apart.Next, an anterior incision was made across the neck and the tissue was pulled apart.

Next, an anterior incision was made across the neck and the tissue was pulled apart.


Muscle was retracted as well, to better reach the thyroid cartilage.Muscle was retracted as well, to better reach the thyroid cartilage.

Muscle was retracted as well, to better reach the thyroid cartilage.


More tools were used to pull the tissue apart for better access.More tools were used to pull the tissue apart for better access.

More tools were used to pull the tissue apart for better access.


A mark was made for the drill location.A mark was made for the drill location.

A mark was made for the drill location.


A mark was made for the drill locationA mark was made for the drill location

A mark was made for the drill location


Next, the drill was used to make a tiny, shallow hole in the thyroid cartilage. This is the patient’s left side of the neck.Next, the drill was used to make a tiny, shallow hole in the thyroid cartilage. This is the patient’s left side of the neck.

Next, the drill was used to make a tiny, shallow hole in the thyroid cartilage. This is the patient’s left side of the neck.


Here is a view of the hole, you can see it clearly.Here is a view of the hole, you can see it clearly.

Here is a view of the hole, you can see it clearly.


A second hole was made on the patient’s right side, mirroring the first hole through the thyroid cartilage.A second hole was made on the patient’s right side, mirroring the first hole through the thyroid cartilage.

A second hole was made on the patient’s right side, mirroring the first hole through the thyroid cartilage.


This is the gortex used for the procedure. It was cut into tiny thin strips.This is the gortex used for the procedure. It was cut into tiny thin strips.

This is the gortex used for the procedure. It was cut into tiny thin strips.


The gortex strip is carefully moved into each hole until the desired distance is achieved for the vocal folds to come to midline.The gortex strip is carefully moved into each hole until the desired distance is achieved for the vocal folds to come to midline.

The gortex strip is carefully moved into each hole until the desired distance is achieved for the vocal folds to come to midline.


The patient was awakened slightly to vocalize by counting to determine how much should be placed. The better they sounded, the less the gortex was moved inward into the holes.The patient was awakened slightly to vocalize by counting to determine how much should be placed. The better they sounded, the less the gortex was moved inward into the holes.

The patient was awakened slightly to vocalize by counting to determine how much should be placed. The better they sounded, the less the gortex was moved inward into the holes.


Multiple trials of this voicing were completed to make sure it was a go. This is the art of the procedure and why surgeons truly have such a huge role in voice improvement.Multiple trials of this voicing were completed to make sure it was a go. This is the art of the procedure and why surgeons truly have such a huge role in voice improvement.

Multiple trials of this voicing were completed to make sure it was a go. This is the art of the procedure and why surgeons truly have such a huge role in voice improvement.


The tissue was sewn up.The tissue was sewn up.

The tissue was sewn up.


And then the skin.And then the skin.

And then the skin.


Finally, some glue helps the tissue stay in place while healing.Finally, some glue helps the tissue stay in place while healing.

Finally, some glue helps the tissue stay in place while healing.

I want to encourage you to keep knocking on doors to see if you can observe surgeries. Bonus if you can sit in on one that is for a patient you care for. This type of interdisciplinary knowledge helps the patient understand more about what went on, what they can expect, and helps provide knowledge for patients moving forward.

 

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on voice science nationally. She is part of the Professional Development Committee for ASHA Special Interest Group 3, Voice and Upper Airway Disorders, and a member of the National Association of Teachers of Singing and the Pan-American Vocology Association. Knickerbocker blogs on her website at  www.atempovoicecenter.com. She has developed a line of kid and adult-friendly therapy materials specifically for voice on TPT or her website. Follow her on Pinterest, on Twitter and Instagram or like her on Facebook.

               

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