Experimental approaches to vocal fold alteration: Introduction to the minithyrotomy

Treatment of challenging laryngeal disorders, such as lamina propria loss o r neuromuscular dysfunction, may require novel approaches and techniques. T his paper discusses an evolution of experimental techniques for treatment o f lamina propria loss and use of the minithyrotomy. These techniques have b een used for surgical access for lamina propria substitution, as well as pl acement of stimulating electrodes. The minithyrotomy is tolerated well by p atients, provides access for microscopic instruments with the surgeon's han d close to the tissue of interest, avoids intralaryngeal mucosal incisions, and lines up the direction of dissection in an anterior-to-posterior orien tation. This orientation is favorable for particular situations herein disc ussed. We present anatomic and physiologic concepts relevant to the surgica l treatment of lamina propria dysfunction, as well as presenting our clinic al experience. This paper is not intended to state how these difficult prob lems should be handled, but rather, to present our experience in techniques that may prove useful through further development.