Ultrasonic surgical aspirator-assisted phonosurgery: a novel technique for laryngeal cartilage dissection.

INTRODUCTION Type I laryngoplasty has become the most dependable procedure for the management of anterior and midglottic incompetence since its classification by Isshiki in 1974. Many procedure variations have emerged, including the development of numerous techniques, implants, and prefabricated systems increasing the utilization of medialization laryngoplasty. Sharp dissection of the cartilage window becomes difficult with calcified thyroid cartilages, often encountered in older men. The surgical drill with a small cutting or diamond burr is used adjunctively to overcome this frequent anatomic variant. Halum et al. first described ultrasonic surgical system thyroplasty window creation in cadavers. The Sonopet ultrasonic surgical aspirator—developed by Synergetics USA, Inc. (O’Fallon, MO) and distributed by Stryker, Inc. (Kalamazoo, MI)—consists of a main control unit (Fig. 1), handpiece, ultrasonic tip, and foot control. This device produces ultrasonic vibrations that selectively grade rigid structures such as cartilage and bone while sparing adjacent soft tissue. The handpiece provides concurrent irrigation and suction (Fig. 2) while a piezoelectric element vibrates the tip at 25 kHz. The ultrasonic vibration moves in two planes, creating longitudinal and torsional forces without grabbing or kicking typical of rotary drill motion. This motion emulsifies tissue without excess heat production and requires minimal downward pressure. This ultrasonic surgical aspirator, initially created for neurosurgical applications, is now being used by a broader group of surgical subspecialties such as plastic surgery, ophthalmology, and oralmaxillofacial surgery. We now describe the first invivo series of the ultrasonic surgical aspirator for laryngeal framework surgery.