Phonosurgery is a set of specialized surgical procedures to improve or restore the voice by modifying the vocal folds. The different types (I–IV) refer to Isshiki's classification system, which describes how the vocal fold is repositioned or reshaped:

Type I (Medialization): Moves a paralyzed or weak vocal fold toward the midline to help it close during speech.

Type II (Lateralization): Used to treat spasmodic dysphonia by moving the vocal fold slightly outward to reduce tension.

Type III (Relaxation): Shortens the vocal fold to lower pitch, often used in transgender voice surgery or certain hyperfunctional voice disorders.

Type IV (Tensioning): This technique lengthens the vocal fold to raise pitch. It is sometimes used to feminize the voice or strengthen weak vocal folds.

These procedures are typically performed under sedation anesthesia, though some can be done under local anesthesia with the patient awake (to fine-tune voice outcome). Recovery includes voice rest for several days, followed by voice therapy to train the new vocal dynamics. Most patients notice a gradual improvement over weeks. Risks include hoarseness, over- or under-correction, or need for revision surgery, but outcomes are generally excellent when tailored to the individual's voice goals.

Laryngofissure is a rare and specialized open surgical procedure used when the larynx must be opened through the front (midline) to access deep or complex problems. It may be used to remove large benign or malignant tumors, correct congenital anomalies, or treat significant trauma. This approach gives the surgeon a direct view and full access to the vocal cords and supporting structures.

Under general anesthesia, a vertical incision is made in the front of the neck, and the thyroid cartilage is split apart to open the larynx. After addressing the underlying issue — such as tumor removal or reconstruction — the larynx is carefully closed and often stabilized with sutures or a stent. Recovery involves a hospital stay, possible temporary tracheostomy, and strict voice rest. The voice may change after surgery depending on the area treated. Risks include infection, scarring, vocal changes, or airway complications, and patients are monitored closely with follow-up scopes and speech therapy as needed.

This procedure is performed to treat a fracture of the larynx — typically the result of blunt trauma to the neck (e.g., car accidents, sports injuries, or assault). Prompt repair is crucial to restore the airway, preserve the voice, and prevent long-term breathing or swallowing issues.

During the operation, the surgeon makes an incision in the neck to access the damaged larynx. The broken cartilage or bone is realigned and secured, and torn soft tissues or vocal folds are repaired. Depending on the severity, a temporary tracheostomy may be placed to protect the airway during healing. Recovery includes hospitalization, voice rest, and gradual return to normal activities. Most patients require follow-up imaging and voice therapy. Many regain normal or near-normal voice and breathing if treated early and correctly. Risks include hoarseness, vocal fold stiffness, airway narrowing, or needing revision surgery.

These are organ-preserving surgeries designed to treat laryngeal cancer while maintaining as much voice and swallowing function as possible. Rather than removing the entire voice box (as in total laryngectomy), these surgeries remove only the cancerous portion of the larynx.

Partial laryngectomy refers broadly to removing part of the larynx.

Hemilaryngectomy involves removing one side of the larynx, often including one vocal fold.

Supraglottic laryngectomy removes structures above the vocal folds (like the epiglottis), preserving the voice.

CHP (Cricohyoidopexy) and CHEP (Cricohyoidoepiglottopexy) are advanced variations used to preserve swallowing while removing cancer-bearing areas.

These surgeries are performed through a neck incision under general anesthesia. A temporary tracheostomy is often required during healing. Recovery involves a hospital stay, speech and swallowing therapy, and close follow-up with scopes. The voice will change depending on the amount of tissue removed — some hoarseness or breathiness is expected. Swallowing usually improves over time. Risks include aspiration (food going down the wrong way), need for feeding tube support, or recurrence of cancer.

These procedures are used to treat bilateral vocal fold paralysis, where both vocal cords are stuck in a closed position, blocking the airway. An arytenoidectomy involves removing part of one of the arytenoid cartilages (which control vocal fold movement) to open the airway. An arytenoidpexy involves repositioning and securing the arytenoid cartilage to improve breathing while trying to preserve voice and swallowing.

The surgery is performed under general anesthesia through a neck incision or sometimes endoscopically, these procedures help patients breathe more freely without relying on a permanent tracheostomy. When done for voice, it repositions the arytenoid cartilage into the proper position. There is a brief hospital stay after surgery to monitor breathing and swallowing. Recovery includes voice rest, monitoring for airway swelling, and gradual reintroduction of speech. The voice may become weaker or breathier after the procedure due to the more open vocal folds, but most patients can communicate effectively. Risks include scarring, aspiration, or need for revision surgery, but results are often life-changing for those struggling to breathe.

This complex reconstructive procedure expands a narrowed or collapsed airway, often due to congenital problems, trauma, or prolonged intubation. A rib graft (usually harvested from the patient) is shaped and used to widen the airway, and a stent is placed to hold the airway open during healing.

Under general anesthesia, the neck is opened to access the airway. The narrowed area is split or removed, and the rib graft is placed to provide structural support. A stent is inserted and remains for several weeks. Patients are monitored closely during hospitalization for signs of swelling or infection. After the stent is removed, breathing and voice are reassessed. Recovery involves frequent follow-ups, and the voice may initially be hoarse or weak but often improves with therapy. This surgery is highly specialized and performed only by surgeons experienced in airway reconstruction.

Tracheal resection is a procedure used to treat narrowing (stenosis) or tumors in the trachea (windpipe). The narrowed or diseased segment of the trachea is removed, and the two healthy ends are reconnected. This surgery restores normal airflow and can be curative in both benign and cancerous conditions.

The procedure is done under general anesthesia through a neck or chest incision. A breathing tube is placed below the area to be removed. Once the diseased portion is excised, the trachea is sutured back together. Recovery includes a hospital stay, close airway monitoring, and limited neck movement to protect the healing site. Most patients breathe more easily right away. Voice is usually unaffected unless the narrowing is near the vocal cords. Risks include wound separation, infection, or scar tissue regrowth. Long-term success is excellent with proper follow-up and sometimes includes additional procedures like dilation.

A tracheal trough procedure is a surgical technique used to create a larger or more stable airway opening in the trachea. It may be performed as part of complex airway reconstruction, often when there has been long-standing tracheostomy use, subglottic stenosis, or tracheomalacia (weak or collapsing trachea). The goal is to improve breathing without the need for ongoing airway tubes.

In this procedure, the surgeon reshapes or removes part of the front of the trachea and may use grafts or stents to maintain the new, wider contour. It is done under general anesthesia, and recovery depends on the extent of the reconstruction. Some patients may need a temporary stent or tracheostomy during healing. Postoperative care includes frequent endoscopic evaluations, airway humidification, and voice rest if vocal structures are involved. This procedure is highly individualized and planned according to airway imaging and scope findings.

This complex surgery treats the combined narrowing of the larynx and trachea, often due to scarring from intubation, autoimmune disease, or trauma. It involves removing and reconstructing the affected airway segment using nearby tissue, grafts, or cartilage support. The goal is to restore both breathing and voice function as fully as possible.

The procedure is done under general anesthesia through a neck incision. The narrowed airway is resected, and the remaining larynx and trachea are joined. Depending on the severity of the case, stents or grafts may be used, and a temporary tracheostomy is often placed. Recovery includes hospitalization, strict airway precautions, and regular endoscopic follow-up. Patients may notice voice changes depending on how close the repair was to the vocal folds. Risks include scarring, recurrence of stenosis, or difficulty swallowing, but many patients experience excellent improvement in breathing and function with proper post-op care.

Zenker’s diverticulectomy is a surgical procedure to remove a pouch-like pocket (diverticulum) that can form at the back of the throat, just above the esophagus. This pouch traps food and liquids, leading to symptoms like bad breath, coughing after eating, choking, and difficulty swallowing.

The surgery can be done through the mouth (endoscopic approach) or through an incision in the neck (open approach), depending on the size and location of the diverticulum. In both cases, the pouch is removed or opened into the esophagus, and the tight muscle (cricopharyngeus) contributing to the problem is cut. Recovery typically includes a short hospital stay, a liquid diet at first, and a gradual return to solid foods. Voice and breathing are usually unaffected, and swallowing improves significantly. Risks include infection, bleeding, or leak at the surgical site, though complications are uncommon with experienced surgeons.

Cricopharyngeal myotomy is a targeted surgical procedure to treat dysphagia (difficulty swallowing) caused by a tight or dysfunctional cricopharyngeus muscle at the top of the esophagus. This muscle should relax during swallowing, but in some people, it stays tight, leading to a feeling of food getting stuck, coughing, or regurgitation.

Under general anesthesia, the muscle is carefully cut, either through a small neck incision or endoscopically through the mouth. Surgical myotomy allows the upper esophagus to open more easily during swallowing. Most patients can eat more comfortably within a few days. A liquid or soft diet is usually recommended during the initial recovery phase. Risks include temporary throat soreness, aspiration, or scarring, but the procedure has a high success rate and significantly improves the quality of life for many patients.

Hypopharyngeal pharyngoplasty is a reconstructive surgery used to reshape or repair the lower part of the throat (hypopharynx), especially after tumor removal, trauma, or congenital deformities. It may also be performed to reduce airway collapse in severe obstructive sleep apnea when other treatments have failed.

The surgeon repositions and reinforces tissues using sutures, flaps, or grafts during the procedure. Pharyngoplasty is aimed at restoring swallowing and speech function. General anesthesia is required, and recovery includes a hospital stay, possible feeding tube support, and speech or swallowing therapy. Healing time varies depending on the complexity, but the goal is always to preserve or regain essential functions like breathing, eating, and speaking. Risks include scarring, aspiration, or wound breakdown, but outcomes are often favorable with good post-op care.

Palatoplasty is a surgical procedure to reconstruct or repair the soft palate. It is usually performed on children with cleft palates, but it can also be used on adults with velopharyngeal insufficiency (VPI)—a condition in which the soft palate doesn't close properly during speech, causing a nasal-sounding voice or air leakage.

The surgery involves repositioning and suturing the soft palate muscles to improve closure during speaking and swallowing. It's done under general anesthesia, and recovery usually involves a soft diet, pain management, and speech therapy. Children often begin to speak more clearly within weeks, though long-term therapy may be needed. In adults, it may improve speech quality and reduce nasal regurgitation of food. Risks include wound breakdown, fistula formation, or the need for additional surgeries, but most patients experience clear functional gains.