Chirurgia indiretta e riabilitazione della voce artistica


12-10-2019 - 09:45

The development of the indirect endoscopical phonosurgery with the new equipments and instruments has increased in the last years. 
The use since the 80’s from the rigid endoscopes 70 and 90 degrees , with recordings systems, HD cameras and  the use of stroboscope aloud the indirect phonosurgery to have enlargement from the images and the functional  advantages.There are new phonosurgical  instruments that are being used. The most important advantage is to view the function under stroboscopy during the surgery. This possibility  helps for a better functional result. All vocal fold pathologies can be surgically treated indirectly like Reinkes oedema, benign and malign tumors, injection or supraglottal pathology . Rehabilitation of the artistic voice in speaking and singing functions before and mainly after phonosurgery is of great importance.

Each patient needs blood tests and cardiovascular examination. An anesthesist perform intravenous sedation and the phonosurgeon applies local anesthesia in the tongue, pharynx and larynx. The patient is awake, in a sitting position.

in a group of 3,000 patients were operated indirectly 
  • 75% cases with benign tumors
  • 15% cases malign tumors
  • 15% cases injection
  • 40% Reinkes oedema
Some cases had two different lesions. 
Rehabilitation programs included resonance, placement, semioccluded   exercises and dynamic routines for reinforcement of the artistic voice mechanism.

The indications  of indirect  endoscopical phonosurgery are for all laryngeal pathologies and it is a great tool for patients  with heart, pulmonary alterations, risks for general anesthesia metabolic disorders, maxillofacial and pharingo-oral difficulties such as  mouth opening, teeth malformations, shortness of the neck , limitation for head hyperextension, thickness of the tongue, or narrow pharynx. In degenerative lesions like papillomatosis or cancer the indirect phonosurgery is useful. The mucosal wave movement during surgery permits a stroboscopical control in all registers, volumes and during singing. Biopsies from a supraglottal lesions can be obtained. The correct treatment of the free edge is easier to control with this indirect approach. Under stroboscopical light  the phonosurgeon can decide different manouvres as planned with freedom in the larynx and vocal folds. 
Rehabilitation for artistic voice is based in the residual capacities before surgery and after phonosurgery the complete speaking and singing voice mechanisms have to be improved. It begins with breathing support , humming , resonance, fricatives  semiocluded   exercises and dynamic routines for body movements during phonation and reinforcement of the artistic vocal mechanism.

Every patient can be operated by this technique.
There are cases that have all the advantages with indirect endoscopical procedure to perform a correct phonosurgery.
The phonosurgeon can have functional information during the procedure.
The cost advantages and less general anesthesia and intubation risks are important factors. 
Rehabilitation of artistic voice needs a complete program to improve and recover the functions for all the expressions of artistic voice.