Laryngeal framework surgery as described by Isshiki, LeJeune, and Tucker offers the opportunity to adjust vocal fold tension. A modification of Isshiki's technique has been applied in ten patients exhibiting the breathiness and quavering voice typical of an “elderly” larynx, eight of whom have been followed long enough to be evaluated, and in two younger patients with similarly unexplained vocal fold flaccidity. Patient selection, technique, and results are reported. The procedure is of limited value in elderly patients because of eventual relaxation of tissues, but seems to provide significant long-term improvement in younger patients.
