Framework surgery

Framework surgery is a widely accepted treatment for vocal fold paralysis; however indications have expanded over time to include other forms of glottal insufficiency. Vocal fold paralysis is the clinical entity that frames our understanding and the historical concepts of what is today known as framework surgery. Over many years adjunct procedures, modifications, and improved clinical evaluation have benefited clinical outcomes. Furthermore, vocal patients can be compared in a number of different measures including visual (videostroboscopy), acoustic (noise-to-harmonic ratio, jitter, shimmer, etc.), and quality of life (voice handicap index, etc.). Initially shaped by our gross anatomic knowledge, fine-tuned by the coverbody theory of vocal fold vibration, and finally research-driven changes based on the biomechanical model will allow us to further improve vocal outcomes in glottal insufficiency with respect to framework surgery.