What is Microlaryngeal Surgery?

Microlaryngeal surgery is a procedure that fixes problems in your throat using a microscope and very small tools (or lasers). This surgery is done while you are under general anesthesia (a medicine that makes you sleep during the surgery so you feel no pain). It is usually an outpatient procedure (a surgery that does not require an overnight stay) performed in the hospital. The surgery typically lasts about 30 to 45 minutes.

During the surgery, a small tube is placed in your throat to help keep your airway safe. Because the surgery is done through your mouth, there is a minimal risk of minor injury to your mouth or teeth. Problems such as tongue numbness or changes in taste are very rare.

What to expect:

The procedure of operative laryngoscopy involves the use of microscopes and other fine instruments and/or lasers to correct vocal cord or laryngeal problems. As such, it is necessary to go under a brief general anesthesia (less than one hour) for this type of surgery. The surgery is usually done on an outpatient basis. You should expect to go home about 2 to 3 hours after surgery, when all is well. It is occasionally necessary to keep a patient overnight for medications and observation. If this is your case, you will be notified when you schedule the surgery.

Before surgery:

It is important to follow these instructions before surgery, especially if you are a singer or a professional voice user.

1. Voice use. The vocal folds must not be vigorously used before surgery. This is to reduce the degree of inflammation and swelling before surgery. It is advisable to not use the voice in any professional capacity 48 hours before surgery. If it is necessary to use the voice professionally, as in shouting or loud singing, please check with us. It is all right to speak quietly but not excessively.
2. Vocal cord health. Reducing irritants to the throat is important. The use of cigarettes, alcohol, and non-essential drugs should be stopped 48 hours before surgery. Prescription drugs may be taken until the surgery unless otherwise specified. Please check with the office if you are on any naturopathic remedies and inhalation treatments and leave us a list.
3. Diet. A regular diet is advised. Milk, chocolates, peanuts (all oily nuts), coffee and spicy foods are to be consumed lightly. In order to prevent reflux, eat smaller meals filling stomach to only 80%. In addition, do not lie down or go to bed immediately after eating. Hydrate your throat by drinking plenty of water, at least 64oz of non-caffeinated beverages per day.
4. Medications. There may be preoperative medications given to you by our office before surgery. If so, please don’t forget to take them. Other medications prescribed by other physicians should be listed with our office. In general, these medications can be taken through the day of surgery. Your internist may need to make adjustments of blood thinner, lung, heart and diabetic medications. Please check with the office if there is any need for medication adjustments.

Recovering from Microlaryngeal Surgery

After the surgery

Your physician will call your family after surgery to go over some post-operative instructions. If your physician does not call after you are ready for discharge, please call (212) 580-1004 and we will reach the doctor for you.

Most people do very well after microsurgery and experience little to no complaints. Pain medication is usually not necessary but may be prescribed for your comfort. You can expect some throat discomfort after the surgery but usually not severe pain. The sensation of excessive phlegm, a need to clear the throat, ear discomfort, and added effort during swallowing may be present for a few days to weeks after surgery, but is usually gone quickly.

1. Voice use. Voice ability will be variable after surgery depending on the procedure. Do not be alarmed if the voice is better right after the surgery than 24 hours after surgery, since swelling from the surgery may take 24 hours before becoming maximal. If you are a voice professional, voice rest for 4 days is usually necessary before trying to speak. With the doctor’s permission on follow up, you may have enough voice to go onto modified voice rest for one week. To check if you are ready for modified voice use, you can do a sigh or gentle hum.... If there is an easily produced sound, you may use it at that pitch for speaking in a quiet room. Loud or stage whisper is not to be used. DO NOT force the voice. If you are a singer or voice professional, you must be checked at one week after surgery to determine if you are ready to go back to work. If you are on voice rest, carry an index card that says: Voice rest. Doctor’s orders. Thank you.
2. Diet. Unless otherwise instructed you may resume your preoperative diet. Please check the post-operative instruction sheet to see if there are any specific dietary restrictions related to your specific surgery.
3. Medication. The medications after surgery may include a brief course of antibiotics and antacids. Occasionally medication for pain is needed. You may use either Tylenol or Tylenol with codeine. Do not use aspirin containing products without checking with the office.
4. Activities. You may resume normal activity 24 hours after surgery with the following restrictions: No weight-lifting or grunting, no wind instrument playing, and no contact sports. Please use caution and avoid noisy environments where shouting may be necessary.
5. Precautions. Avoid coughing and aggressive clearing of the throat. Swallow plenty of water to soothe the throat. Non-caffeinated orange spice tea with a wedge of lemon and tablespoon of honey is soothing and will help to calm irritation and dryness. Smoking, alcohol and other non-prescription drugs are not to be used for one week after surgery.
6. Follow-up and return to normal voice use. Follow up is usually arranged at one week after surgery. If you have special requirements for work, you may be checked sooner. You may work with a voice therapist after the first post-operative period to get the voice going again in a healthy way. Please plan accordingly.

What are Phonosurgery and Open Laryngeal Surgery?

The term "phonosurgery" comes from the Greek word "phōnē," which means voice or sound; therefore, phonosurgery means "surgery on the voice." It refers to procedures that are specifically designed to improve or modify how the voice sounds. In open surgery, the surgeon makes an incision (cut) in the neck over the laryngeal area, fixes the problem, and then closes the wound. Phonosurgery involves working on the laryngeal framework, muscles, or tissues to change the sound of your voice.

What to expect:

Laryngoplasty and other phonosurgeries involve surgery of the laryngeal framework and/or laryngeal muscles, or the arrangement of tissues to change the voice. As such, most operative procedures are done with either brief general anesthesia (one hour) or under local anesthesia with sedation. The surgery is done in an operative suite. Local anesthesia will be applied by the surgeon and augmented by intravenous medication. Most patients sleep right through until it is time to test the voice. The surgery is usually done as outpatient or with one overnight stay. An overnight stay is necessary if you have a surgical drain or if it is necessary to keep you overnight for medications and for observation. If this is your case, you will be notified at the time you schedule the surgery. Surgeries of this type vary in complexity; please do not be alarmed if you are scheduled to be admitted after surgery.

Before surgery:

It is important to follow the following instructions before surgery, especially if you are a professional voice user.

1. Voice use. It is all right to speak quietly but not excessively for 48 hours prior to your surgery.
2. Vocal cord health. Reducing irritants to the throat is important. The use of cigarettes alcohol, and non-essential drugs should be stopped 48 hours before surgery. Prescription drugs may be taken until the surgery unless otherwise specified. Please check with the office if you are on any naturopathic remedies and/or inhalation treatments, and leave us a list.
3. Diet. A regular diet is to be followed before surgery. Milk, chocolates, peanuts (all oily nuts), coffee and spicy foods should be consumed lightly, if at all. To prevent reflux, especially 48 hours before your surgery, eat small meals, filling the stomach to 80%. In addition, do not lie down or go to bed immediately after eating. Hydrate your throat by drinking plenty of water, at least 64oz of non-caffeinated beverages a day 48 hours before surgery.
4. Medications. There may be preoperative medications given to you by our office before surgery. If so, please don’t forget to take them. Medication prescribed by other physicians should be listed with our office. In general, your medications can be taken through the day of surgery. Your internist may need to make adjustments of blood thinner, lung, heart and diabetic medications. Please check with the office if there is any need for medication adjustments. Preoperative medical evaluations and clearance may be requested from your internist before your surgery.

Recovering from Laryngoplasty and Other Phonosurgery

Each operation has been customized to the needs of the patient. This section seeks to list common post-operative routine for selected surgeries that are performed by Dr. Woo. This is not meant to be in substitution to the more specific information given at the date of surgery, but as an adjunct for patients seeking general care information.

After the surgery

Your physician will call your family after surgery to go over some post-operative instructions. If your physician does not call after you are ready for discharge, please call (212) 580-1004 and we will reach the doctor for you.

Most people do very well after laryngoplasty and other phonosurgery and experience little to no complaints. You can expect some throat discomfort after the surgery but usually not severe pain. The sensation of excessive phlegm, a need to clear the throat, ear discomfort and added effort during swallowing may be present for a few days to weeks after surgery but is usually gone quickly. The main problems after surgery that may be experienced are temporary throat discomfort, some transient restriction of neck movements and occasional swallowing difficulties.

1. Voice use. Voice ability will be variable after surgery depending on the procedure. Do not be alarmed if the voice is better right after the surgery and then somewhat diminished 24 hours after surgery, since swelling from the surgery may take 24 hours to become maximal. The voice usually returns fully about one week after surgery. If you are a professional voice user, voice rest for 4 days is usually necessary before trying to speak. With the doctor’s permission on follow up, you may have enough voice to go onto modified voice rest for one week. To check if you are ready for modified voice use, you can do a sigh or a gentle hum. If there is an easily produced sound, you may use it at that pitch for speaking in a quiet room. Loud or stage whisper is not to be used. DO NOT force the voice. If you are on voice rest, carry an index card that says: Voice rest. Doctor's orders. Thank you.
2. Diet. Unless otherwise instructed, you may resume your preoperative diet after surgery. The consistency of the diet may need to be adjusted by you if you find certain liquids or solids are difficult to swallow. Hard foods such as peanuts and chips are best avoided. Please check the post operative instruction sheet to see if there are any specific dietary restrictions related to your specific surgery.
3. Medication. The medications after surgery may include a brief course of antibiotics and antacids. Occasionally, medication for pain is necessary, such as Tylenol or Tylenol with codeine. Do not use aspirin containing products without checking with the office. Stronger pain medications are prescribed if Tylenol with codeine is not enough. If you are on other prescription medications by other physicians, you may resume your other medications after the surgery with the exception of blood thinners. Please check with us if you are on blood thinners as to when you can resume these medications.
4. Work and other Activities. You may resume normal activity 24 hours after surgery with the following restrictions: No weight-lifting or grunting, no wind instrument playing and no contact sports, as limited neck movements may be necessary to keep the wound healthy and permit healing. Please use caution and avoid environments where shouting or heavy neck movements may be necessary. We do not recommend work for one week after surgeries unless it is sedentary work that does not involve speaking.
5. Precautions. Avoid coughing and aggressive clearing of the throat. Swallow plenty of water to soothe the throat. Non-caffeinated orange spice tea with a wedge of lemon and tablespoon of honey is soothing and will help to calm irritation and dryness. Smoking, consuming alcohol and other non-prescription drugs should be avoided for one week after surgery, though keep in mind: these are always harmful to the vocal cords. Call the office if you experience fever, worsening neck swelling, swallowing or breathing difficulties or oozing from the wound.
6. Follow up and return to normal voice use. Follow up is usually arranged for one week after surgery. If you have special requirements for work, you may be checked sooner. You may work with a voice therapist at the first postoperative appointment to get the voice going again in a healthy way. Please plan accordingly.
7. Dressing care. The incision should be cleaned once a day with peroxide and covered with a thin layer of antibiotic ointment. This should be covered with gauze for 7 days. You may take a shower with care to keep the wound covered.

Q: I know I can’t talk after surgery, but can I whisper or cough or clear my throat?

Q: May I fly between my surgery and post op? I’d like to fly the day after my surgery, is that okay?

Q: How soon can I get back to the gym? I’m on a tennis league, can I play ball sports?

Q: I talk a lot at my job, when can I go back to work and talk all day, every day?

Q: Am I going to be on a liquid/ice cream only diet after surgery?

Q: How much does this hurt? Am I going to be on bed rest after?

Q: Is there a locker at the hospital to put my things in while I’m having surgery?

Q: Why do I have to get there two hours before my surgery?

Q: How soon after my surgery is over do I get to leave the hospital?

Q: Can my family be in the recovery room with me after surgery?

Q: Will I get to see the doctor before I’m under anesthesia if I have any last minute questions?

Q: How soon will my Pathology Report be ready after my surgery?

Q. Can I wear contacts or nail polish to surgery?

This is our general clearance package.

• Surgery at the Mount Sinai Hospital (Manhattan)
• Fill in Clearance Form with guidelines

Patients are given specific instructions as to testing requirements and who and where to obtain clearance. Certain patients must obtain their Preoperative Medical Assessment (POMA) clearance from doctors at the Mount Sinai Anesthesia Department.