Thyroarytenoid Myectomy or Myoneurectomy for Adductor Spasmodic Dysphonia
The forces that bring the vocal folds together can be weakened by directly cutting the muscles that move the vocal folds (myectomy) or by cutting the nerves and the muscles together (myoneurectomy). These procedures have been performed for adductor spasmodic dysphonia in small numbers of patients since at least the 1990s.
The muscles of the voice box can be accessed by making an incision in the neck (transcervical approach) or by making an incision in the lining of the voice box accessed through the mouth (endoscopic approach). A laser is typically used in the latter endoscopic approach. These specific procedures for spasmodic dysphonia are not commonly performed even by laryngologists.
The transcervical procedure may be performed under local or ‘twilight’ anesthesia whereas the endoscopic procedure would always be performed under general anesthesia. Following the operation, patients may stay overnight or be discharged the same day depending on patient and surgeon preference.
• Reduction of vocal fold spasms
• Improvement of vocal fluency
• Adductor spasmodic dysphonia (not mixed, not Abductor)
• No vocal tremor (vocal tremor is not taken away in surgery)
• Able to tolerate a general anesthetic
• An option for patients interested in a surgical approach
• Has a vocal tremor
• Medically frail
• Unable to tolerate a general anesthetic
• Scarring of vocal folds
• Harsh or weak voice quality
• Need for revision procedures have been described
Transcervical Myectomy | Peer-reviewed reports of outcomes are very limited and while favorable, are hard to generalize.
Endoscopic Myoneurectomy | Very limited literature from doctors in the United States but foreign peer-reviewed outcomes of patients for up to three years after the procedure have been favorable.