Quiz 8 - 🩺 Surgery, GAVC, Clefts & Resonance Disorders — Case Scenarios (18 total)

1. Surgical Indication

Case: A client with a persistent vocal lesion has completed months of therapy without improvement.
Question: When is surgical intervention indicated for a vocal fold pathology?

When therapy cannot yield desired results, when lesion appears suspicious, or when airway must be maintained.

2. Office-Based Procedures

Case: An ENT performs a biopsy on a vocal fold lesion using a flexible scope under local anesthesia.
Question: What type of procedure is this and what are its benefits?

Office-based flexible laryngoscopy — allows minor procedures with topical anesthesia, faster recovery, and immediate voice feedback.

3. Microflap Dissection

Case: A singer has a submucosal cyst requiring precise removal while preserving mucosa.
Question: What surgical technique is most appropriate?

Microflap dissection — incision in the VF surface, removal from Reinke’s space, and re-draping of tissue for healing.

4. Laser Laryngoscopy

Case: A patient with recurrent papilloma requires targeted removal of lesions.
Question: Why is a CO₂ laser commonly used in laryngeal surgery?

It provides precise cutting with minimal tissue damage, reduces bleeding, and maintains airway visibility.

5. Injection Laryngoplasty

Case: A client with unilateral VF paralysis undergoes an in-office injection to improve glottic closure.
Question: What is the purpose of injection laryngoplasty?

To temporarily medialize the paralyzed vocal fold and improve voice and swallowing during recovery.

6. Thyroplasty

Case: One year post-recurrent laryngeal nerve damage, a client’s voice remains breathy.
Question: What surgical procedure offers a permanent solution?

Type I (medialization) thyroplasty — places an implant to push the paralyzed fold toward midline.

7. Bilateral VF Paralysis

Case: A patient with bilateral paralysis presents with stridor and limited airway.
Question: What surgical option can enlarge the glottic gap?

Cordotomy — divides the vocal fold posteriorly to improve breathing while maintaining limited phonation.

8. SLP Role Post-Surgery

Case: Post-surgery, the patient asks when they can resume speaking.
Question: What is the SLP’s role in voice surgery recovery?

Educate on voice rest, hygiene, gradual reintroduction of phonation, and post-op therapy for efficient voice use.

9. Gender-Affirming Voice Care

Case: A transgender woman seeks a higher-pitched, more feminine voice.
Question: What are common goals of gender-affirming voice therapy?

Raise habitual pitch, increase forward resonance, adjust prosody, and promote vocal femininity through safe techniques.

10. Gelfer’s Approach

Case: During therapy, a transwoman practices /m/-initiated syllables at target pitch using a clear voice.
Question: Which structured therapy model does this follow?

Gelfer’s oral resonance approach — progresses from syllables to conversation focusing on pitch, resonance, and intonation.

11. Surgical Pitch Modification

Case: A transgender female undergoes a procedure to increase vocal fold tension.
Question: What surgery achieves this?

Cricothyroid approximation (Type IV thyroplasty) — increases VF tension and raises fundamental frequency.

12. Cleft Classification

Case: A newborn has a bilateral cleft extending through the alveolus and lip.
Question: What type of cleft is this and when does it form embryologically?

Complete bilateral cleft of the primary palate — develops around 7 weeks gestation.

13. Secondary Palate Cleft

Case: A child presents with hypernasality and nasal regurgitation.
Question: What structural abnormality likely causes these symptoms?

Cleft of the secondary palate — results in velopharyngeal insufficiency and feeding problems.

14. Submucous Cleft

Case: A child’s oral exam reveals a bifid uvula and translucent line along the velum.
Question: What condition is suspected and what is the classic triad?

Submucous cleft palate — bifid uvula, zona pellucida, and posterior hard palate notch.

15. Hypernasality

Case: During speech, a child produces /b/ as /m/ and vowels sound nasal.
Question: What resonance disorder is present and what causes it?

Hypernasality — excessive sound in nasal cavity due to velopharyngeal insufficiency or large oronasal opening.

16. Hyponasality

Case: A child sounds “stuffy” with reduced nasal resonance on /m/ and /n/.
Question: What might cause this resonance change?

Obstruction of nasal cavity or nasopharynx from enlarged adenoids, congestion, or nasal blockage.

17. Cul-de-Sac Resonance

Case: A client’s speech is muffled and low in volume despite normal articulation.
Question: What resonance disorder might this be?

Cul-de-sac resonance — sound trapped in the oral, nasal, or pharyngeal cavity due to blocked exit.

18. Mixed Resonance

Case: A child demonstrates hypernasality on vowels but hyponasality on nasal sounds.
Question: What type of resonance disorder is this?

Mixed resonance — combination of hypernasality and hyponasality on different sounds, often from VPI and obstruction.