Surgery to Lower Vocal Pitch: A-P Relaxation

Abstract

Surgery to lower vocal pitch was, to my knowledge, first reported by myself, experimentally (Isshiki et al. 1974¹⁵) and clinically (Isshiki 1977⁵, 1980³, 1981⁴; Isshiki et al. 1983¹⁸). The principle is, like the technique, simple. The vocal cord is relaxed by antero-posterior (A-P) shortening of the thyroid ala, which is achieved by vertical strip excision of the thyroid ala (Fig. 7.1). The pitch lowering has been dramatic and permanent except in those patients with attendant vocal cord scarring or atrophy, in whom the results have not been so marked. Tucker (1985¹⁸) described one patient in whom an excessively high vocal pitch was lowered by dorsally displacing a superiorly based cartilage flap (which was made at the anterior portion of the thyroid ala), thereby displacing the anterior commissure backward. As a treatment for sulcus vocalis, Niimi et al. in 1973¹⁵ reported a surgical technique to slacken the vocal cord by pressing dorsally a square cartilage piece around the anterior commissure.