Impacts and limitations of medialization thyroplasty on swallowing function of patients with unilateral vocal fold paralysis

AbstractBackground:Medialisation thyroplasty is considered the ‘gold standard’ treatment for unilateral vocal fold paralysis, enabling improvement of voice and swallowing function, and preventing life-threatening aspiration events. The most commonly used laryngeal implants induce some degree of local tissue inflammatory response, and carry the risk of immediate or delayed implant extrusion.Methods:This paper describes a novel approach for medialisation thyroplasty. Specifically, it utilises a ribbon of autologous tensor fascia lata harvested at the time of surgery. This is layered within the paraglottic space in a manner similar to Gore-Tex thyroplasty.Results:Thus far, this method has been accomplished in two patients with unilateral vocal fold paralysis, who also received prior radiotherapy to the head and neck.Conclusion:Given the increased risk of post-operative wound breakdown and infection in irradiated patients, it is suggested that this new approach will lead to improved outcomes, and a decrease in complications such as extrusion or wound infection, particularly in this patient population.

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Comparison of Voice Outcomes between Medialization Thyroplasty and Arytenoid Adduction with or without Injection Laryngoplasty in Unilateral Vocal Fold Paralysis Patients

Journal of The Korean Society of Laryngology Phoniatrics and Logopedics ◽

10.22469/jkslp.2017.28.2.118 ◽

2017 ◽

Vol 28 (2) ◽

pp. 118-122

Author(s):

Hokyung Jin ◽

Seong Jun Won ◽

Nayeon Choi ◽

Young-Ik Son

Keyword(s):

Vocal Fold ◽

Vocal Fold Paralysis ◽

Injection Laryngoplasty ◽

Unilateral Vocal Fold Paralysis ◽

Arytenoid Adduction ◽

Medialization Thyroplasty

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Novel Approach of Medialization Thyroplasty with Arytenoid Adduction Performed under General Anesthesia with a Laryngeal Mask

Otolaryngology ◽

10.1177/0194599811427811 ◽

2011 ◽

Vol 146 (2) ◽

pp. 266-271 ◽

Cited By ~ 13

Author(s):

Nicholas W. Stow ◽

Jennifer W. Lee ◽

Ian E. Cole

Keyword(s):

Vocal Fold ◽

Case Series ◽

Vocal Fold Paralysis ◽

Laryngeal Mask ◽

Unilateral Vocal Fold Paralysis ◽

Maximum Phonation Time ◽

Arytenoid Adduction ◽

Medialization Thyroplasty ◽

The Voice

Objective. To objectively assess the voice outcomes of patients with unilateral vocal fold paralysis treated with medialization thyroplasty and arytenoid adduction suture. Study Design. Case series of patients who underwent medialization thyroplasty and arytenoid adduction suture. Preoperative and postoperative voice testing was performed and the data were compared by statistical analysis. Setting. Tertiary referral teaching hospital in Sydney, Australia. Subjects. All patients had a unilateral vocal fold paralysis, with a large posterior glottic gap and vocal symptoms affecting their quality of life. Methods. Thirteen patients with a diagnosis of a unilateral vocal fold paralysis with a large posterior glottic gap, vocal symptoms, and total denervation of the vocal fold underwent medialization thyroplasty and arytenoid adduction suture. The surgery was performed in a novel method under a general anesthetic using a laryngeal mask and with direct intraoperative endoscopic feedback. Preoperative and postoperative measures of voice performance were compared, including acoustic analysis (fundamental frequency, speech intensity against quiet and loud background noise, speech rate) and aerodynamic assessment (airflow, maximum phonation time). Results. Medialization thyroplasty with arytenoid adduction suture significantly improved aerodynamic assessment and phonation duration for both male and female subjects overall. There were 2 of 13 treatment failures. Median follow-up time was 6 months. Conclusion. Preliminary results indicate that in selected patients with vocal fold paralysis, medialization thyroplasty with arytenoid adduction suture leads to significant improvements in objective voice measures. Longer follow-up data are required to further quantify the voice outcomes after this procedure.

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