Injection laryngoplasty recovery
Laryngoplasty
Often in medicine, our ability to treat disease outpaces our reconstructive capacity. This was long the case in Otolaryngology which for years provided curative surgery but had little to offer patients who suffered cosmetic and functional defects after. The past century, however, served as a period of ‘catch-up’ and the larynx also finally garnered the attention it deserved. We now have options to improve the quality of life of patients whose illnesses or treatments have left them with vocal cord paralysis (VCP). VCP can result from myriad causes including viral illnesses, brain diseases, and surgical or traumatic injuries to the laryngeal nerves. For these patients, the inability to fully close the glottis can result in breathy, unpredictable voices as well as dysphagia and decreased cough strength. In order to achieve optimal function, patients require a team approach that gives them both the anatomic and technical tools to generate good voice.
What is Laryngoplasty?
The ideal surgical treatment would move the vocal fold margin medially so that the mobile one would meet it without interfering with phonatory vibration of either. In 1974, Dr Nobuhiko Isshiki of Kyoto, Japan, described several types of laryngoplasty including one that accomplished the medialization of the vocal fold and improved glottic closure. Over many decades, the technique has been refined and has emerged as an essential tool for surgical voice rehabilitation.
How Does Laryngoplasty Work?
Medialization laryngoplasty involves exposing the larynx through an incision in the neck and creating a ‘window’ in the cartilage through which an implant can be placed while the larynx is observed with a flexible scope. Many different materials are used as implants including carved silastic or ceramic blocks, Gore-tex® strips, and silastic shims. The procedure is usually performed using a special anesthesia technique as there are periods when the patient must be comfortable enough to tolerate the operation but during the placement of the implant, s/he must be alert enough to respond to commands and speak so that the size can be customized. Patients are usually observed overnight in the hospital and discharged the following morning if there are no complications. Surgical risks include infection, bleeding and the possibility of an implant moving or extruding into the airway. They can also be made too small, too large and placed incorrectly. When done well, patients will experience an improvement in objective measures like loudness, maximum phonation time and noise-to-harmonic ratio as well as subjective improvements in breathiness, effort of phonation and vocal predictability. These changes are considered permanent and generally do not decline over time.
What Is Injection Laryngoplasty?
In addition to above surgical structural change, there are also injectable implants available. This option uses materials as diverse as fat, human dermis, cultured hyaluronic acid (a component of human joint fluid), and an engineered bone analogue. The advantage of this technique is that, with the right patient and material, it can be performed under local anesthesia with the patient awake in the office. This reduces both the cost and time spent on the procedure. For those who are too nervous for this, it can also be done under general anesthesia and remains quick and effective. There is mounting evidence that injections of fat and bone dust can last for many years and that the durability of the results is comparable with those from laryngoplasty. These injections do, however, require a skilled hand as they carry risks of bleeding and possibly permanent voice damage if one material is injected improperly.
Laryngoplasty After Surgery Care
. Incision: If there is an incision in your neck, this will be covered with skin glue. You will need to keep this dry for 5 days. When you shower, cover this with a bandage, then remove the bandage after the shower and pat the incision dry. After the 5th day, you can shower normally and let the incision get wet. After the shower cover the incision with facial moisturizer or antibiotic ointment and rub in softly, do not produce pain. This will help the incision heal without scar tissue.
. Drain: If there is a drain present, you will be asked to return to the office the following day for removal. Keep the drain site dry and do not get it wet in the shower.
. Sleeping: Please sleep with your head and upper body elevated to 30 degrees on pillows.
. Activity: Do not strain, do heavy lifting or hard exercise that involves the upper body for 2 weeks. This is to avoid putting pressure on your larynx as this could cause the larynx to break after the surgery.
. Diet: You can eat your regular diet. However, the first night after anesthesia, it is best to keep your diet light to avoid nausea.
. Voice Use: In general, you can speak when needed. Your voice will be hoarse or rough in a different way than before surgery. This will last for 2 to 4 weeks. Please do not push to produce voice. If it is too effortful, then limit your speaking.
. Pain: Most patients find that regular Tylenol is effective to control pain. There will be a narcotic pain medication called in to your pharmacy that you should pick up to have on hand to use if the acetaminophen is not adequate.
. Do not drive, operate dangerous machinery, or do anything dangerous if you are taking narcotic pain medication (such as oxycodone, hydrocodone, morphine, etc.) This medication affects your reflexes and responses, just like alcohol.
. Antibiotics: You will be prescribed antibiotics for 5 days if an implant has been left in your larynx. Please follow the instructions on the bottle for use.
About Iranian Surgery
Iranian surgery is an online medical tourism platform where you can find the best otolaryngologists in Iran. The price of Laryngoplasty in Iran can vary according to each individual’s case and will be determined by an in-person assessment with the doctor.
For more information about the cost of Laryngoplasty in Iran and to schedule an appointment in advance, you can contact Iranian Surgery consultants via WhatsApp number 0098 901 929 0946. This service is completely free.
Source:
10 common questions about Injection laryngoplasty recovery
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