The following are lists of the different procedures and approaches for the more commonly occurring ‘throat / breathing problems’. I apologise for any omissions and I would be very pleased to hear from anybody who would like to assist in updating these.
LARYNGEAL - a glance at the head diagram on this site reveals a number of operable conditions of the larynx. Laryngeal weakness is graded from I - IV or I - V with mid gradings where applicable. For simplicity sake ‘minor’ refers to those states where the condition although causing turbulence / noise is not seen to be significantly affecting performance.
1) Laryngeal weakness (paresis) - minor- (i) - Ventriculectomy of the lateral laryngeal ventricle (Hobday) (a) Unilateral.. affected side only (b) Bilateral (ii) - Chordectomy as well as ventriculectomy . Removal of the vocal fold / chord. (a) Unilateral (b) Bilateral
2) Laryngeal weakness severe through to paralysis. (i) - Abductor prosthesis (Tie-back) (a) With unilateral (affected side) ventriculectomy with or without chordectomy. (b) With bilateral ventriculectomy with or without chordectomy (c) Abductor prosthesis alone. (ii) - Nerve Muscle Pedicle Graft -alternate nerve innervation to partially paralysed laryngeal muscle. (a) Single graft (b) Multiple grafts (c) With or without a ventriculectomy. (iii) - Partial Arytenoidectomy- usually also unilateral (affected side) ventriculectomy and chordectomy.
3) Chondritis of arytenoid cartilage- (i) - curettage accompanied by appropriate medical therapy (ii) - Partial Arytenoidectomy.
4) - Dynamic collapse of the vocal folds- (i) Resection (chordectomy) and ventriculectomy (a) Unilateral (b) Bilateral
5) Fourth Branchial Arch Defect (4BAD)- ‘rostral displacement of the pharyngeal arch -None-
NB. The following procedures as with the above laryngeal procedures may be accomplished in a variety of ways by surgeons using different approaches and instrumentation. These details should be obtained from your surgeon and are not discussed here.
PHARYNGEAL - 1) DDSP (Dorsal Displacement of The Soft Palate), pre DDSP behaviour (Dorsal movement of the rostral soft palate) and different forms of ‘dynamic pharyngeal collapse. (i) Caudal palatine resection- (a) thin strip resection (b) V piece resection (ii) Strap Muscle resection - removal of a section of sternhyoideus muscle and sternothyroideus muscle. (a) small resection- approx 1-2 inches (b) larger resection- 6-8 inches (iii) Tenectomy of the sternothyroideus muscle (a) with resection of a portion of sternohyoideus muscle (b) with a caudal palatine resection (iv) Epiglottic augmentation- with polytetrafluoroethylene paste (v) ‘Hot firing’ -of the ventral surface of the soft palate (under anaesthetic) (a) needle firing (b) more expansive cautery. (vi) Sclerosing - of the ventral mucosa of the soft palate - with selected irritants (vii) Laser firing- of the dorso-caudal border of the soft palate. (viii) Oral Palatopharyngoplasty (OPP) -Surgery to tense the mid and rostral soft palate and to reduce subepiglottal mucosal mobility.
NB. Not uncommonly several procedures are performed concurrently. The surgeon will of course explain his / her selection of procedures.
2) Epiglottic Entrapment - by varying conglomerates of subepiglottal mucosas. (i) Midline division of the mucosas - (a) Per -nasum, via the nose (b) Per-os, via the mouth (ii) Partial resection - of the mucosas (entrapping) dorsal to the epiglottis (iii) Total resection of the entrapping mucosas.- -dorsal and ventral to the epiglottis. NB:- All these procedures can be performed using laser surgery.
3) Dynamic collapse of the aryepiglottic folds- (i) Surgical resection of the folds (ii) Laser removal of the folds (ii) Resection of the subepiglottal mucosas including the ventro-lateral mucosa (redundant) of the aryepiglottic folds. The primary fold is maintained.
This is a guide to the available techniques and does not attempt to suggest the relative worth of one procedure v’s another. These factors should be explained by your surgeon.
NB... See - ‘Breathing Problems and Surgery for These’ Updated. - ‘Diagram -horse head’
