الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Insufficient closure of the vocal folds lowers the quality of voice and may lead to swallowing difficulties. Subsequent symptoms including hoarseness, breathiness or aphonia and aspiration appear in correlation with the severity of glottic gap Phonosurgery is defined as any surgery designed primarily for improvement or restoration of the voice Many conditions may cause glottic insufficiency such as neuromuscular paralysis or paresis, secondary to aggressive resection of the benign lesion, loss of the native tissue of vocal folds after tumor resection, and presbylarynx or sulcus vocalis Medialization thyroplasty and injection laryngoplasty are the basic surgical modalities successfully used in the surgical management of glottic insufficiency. However the management of glottic insufficiency should be individually planned for every patient and the size of glottic gap is an important issue dealing with the management of glottic insufficiency In this study we use silicone block as a shim to medialize the vocal fold under local anesthesia, as it is cheep and easily applicable throw a window in the thyroid ala at the level of the vocal fold with simultaneous flexible laryngoscopy monitoring. Adjustments can be made to the implant based on the findings of the.