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Valley ZA, Karp A, Garber D. Safety and Adverse Events of Medialization Thyroplasty: A Systematic Review. Laryngoscope 2024; 134:1994-2004. [PMID: 37916789 DOI: 10.1002/lary.31141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Unilateral vocal fold paralysis or paresis (UVFP) is a condition that causes significant morbidity due to dysphonia, dysphagia, and aspiration. Type I medialization thyroplasty (MT) is the current mainstay surgical treatment for UVFP. Though widely considered a safe procedure, concerns exist over possible airway complications which can lead to overnight observation. Herein, we report a systematic review of the safety and adverse events of MT to aid in determining the safety of same-day discharge. DATA SOURCES PubMed and Embase databases. REVIEW METHODS Our search identified studies investigating complications associated with MT. Articles were selected if published between January 1, 1989 and March 15, 2023. Abstracts were screened, and data were extracted from included studies. Only Type I MT procedures were included; case reports were excluded. Participant characteristics, intervention details, results, and adverse events were extracted. RESULTS The database query identified 751 abstracts, of which 46 studies met eligibility criteria. A total of 2426 patients underwent MT. The most common implant was Silastic (n = 898, 37.0%) followed by Gore-Tex (n = 664, 27.4%). There were 254 (10.5%) total complications reported; 110 (4.5%) were considered major. The most common complication was nonobstructive hematoma (n = 59, 2.4%) followed by hemorrhage (n = 36, 1.5%). Implant extrusion (n = 24, 0.99%) or displacement (n = 15, 0.62%) occurred mostly in Silastic and Gore-Tex implants. Same-day discharge occurred with 429 patients and was not associated with adverse events. CONCLUSIONS UVFP can be reliably improved by MT with a low risk of complications. Outpatient MT is a promising treatment with a favorable safety profile. Laryngoscope, 134:1994-2004, 2024.
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Affiliation(s)
- Zachary A Valley
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Avrohom Karp
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - David Garber
- Department of Otolaryngology-Head and Neck Surgery, Westchester Medical Center, Valhalla, New York, USA
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Entezami P, Tritter A, Shaha M, Ware E, Chang B. A systematic review and meta-analysis on the outcomes of type I thyroplasty in the irradiated neck. Am J Otolaryngol 2023; 44:103769. [PMID: 36640533 DOI: 10.1016/j.amjoto.2022.103769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Type I thyroplasty has been well-documented as a safe and effective treatment modality for vocal fold motion impairment, as well as other select cases of persistent glottic insufficiency. However, history of prior radiation to the neck has traditionally been viewed as a relative, if not formal contra-indication to this procedure. The objective of this systematic review was to analyze all available data in the literature on type I thyroplasty in previously irradiated patients and perform a meta-analysis assessing whether complications and revision rates are significantly different between radiated and non-irradiated patients. Secondary outcomes were to compare voice outcomes between these cohorts. METHODS Several databases were screened for relevant citations using the PICO process. The quality of studies and risk of bias were evaluated using the MINORS scoring system. Main endpoints for analysis in this study were complication rate and revision rate. Secondary endpoint was reported voice outcome. RESULTS Three articles were included in the analysis. Zero major complications were reported, including no instances of implant extrusion or explantation. There was an 11.8 % rate of minor complications. There were similar rates of revision between radiation and control groups. There was no significant difference in voice outcomes between groups. The average MINORS score of the studies suggested a high risk of bias. CONCLUSIONS Based on limited quality evidence, this review suggests that type I thyroplasty is safe and feasible in carefully selected irradiated patients, with comparable complication and success rates as their non-irradiated cohorts. Further large-scale studies are warranted.
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Affiliation(s)
- Payam Entezami
- Department of Otolaryngology/Head & Neck Surgery, LSU Health Shreveport, Shreveport, LA, USA
| | - Andrew Tritter
- Department of Otorhinolaryngology - Head & Neck Surgery, UTHealth Houston, Houston, TX, USA
| | - Manish Shaha
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erin Ware
- Medical Library, LSU Health Shreveport, Shreveport, LA, USA
| | - Brent Chang
- Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
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Song SA, Santeerapharp A, Choksawad K, Franco RA. Revisions and complications with Gore-Tex medialisation laryngoplasty: A 19-year experience. Clin Otolaryngol 2021; 46:864-868. [PMID: 33580577 DOI: 10.1111/coa.13739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/07/2021] [Accepted: 01/31/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Sungjin A Song
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Alena Santeerapharp
- Faculty of Medicine, Department of Otorhinolaryngology, Srinakharinwirot University, Bangkok, Thailand
| | - Kanittha Choksawad
- Department of Otolaryngology, Panyananthapikkhu Chonprathan Medical Center Srinakharinwirot University, Bangkok, Thailand
| | - Ramon A Franco
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA.,Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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Orbelo DM, Ekbom DC, Van Houten HK, Bayan SL, Balakrishnan K. Speech Pathology Utilization and Stroboscopy Before and After Adult Medialization Laryngoplasty. J Voice 2020; 36:423-433. [PMID: 32690345 DOI: 10.1016/j.jvoice.2020.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Evaluation of trends and utilization of speech-language-pathology (SLP) services, including stroboscopy, before and after medialization laryngoplasty (ML) over 11 years. METHODS Retrospective national US database study conducted using OptumLabs Data Warehouse. Study cohort included patients (age ≥18 years) who underwent ML between January 2007 and December 2016. Primary outcomes were rates of SLP visits in the 12 months before and 12 months after ML. Linear regression analysis was performed assessing for trends utilization across years. Secondary outcomes were predictors of utilization After-ML using multivariable logistic regression. RESULTS 1114 patients met criteria. Services, including stroboscopy, were utilized by 774 (69%) Before-ML and 697 (63%) After-ML. SLP services, excluding stroboscopy, were utilized by 512 (46%) Before-ML and 478 (43%) After-ML. Vocal cord paralysis was the most common diagnosis, 945 (84.8%) patients. Other service billed were stroboscopy, [Before-ML 676 (60.7%); After-ML 567 (50.9%)], voice evaluation [Before-ML 431(38.7%); After-ML 366 (32.9%)], voice therapy [Before-ML 309 (27.7%); After-ML 339 (30.4%)], laryngeal function studies, [Before-ML 175 (15.7%); After-ML 164 (14.7%)], swallow evaluations [Before-ML 150 (13.5%); After-ML 90 (8.1%)], and swallow therapy [Before-ML 53 (4.8%); After-ML 47 (4.2%)]. SLP utilization Before-ML predicted SLP utilization After-ML [Odds Ratio (95% Confidence Interval): 9.31 (6.78, 12.77)]. Nearly half (49%) of visits occurred in the 6 months around ML. Of those who had voice therapy, the majority (73.7%) had a total of 1 to 5 sessions. CONCLUSION Based on this retrospective US national database study, SLP services and stroboscopy are a complementary component of assessment and treatment of patients who undergo ML with the majority of services occurring in the 3 months before and after ML. Future work would benefit from outcome data.
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Affiliation(s)
- Diana M Orbelo
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota.
| | - Dale C Ekbom
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Holly K Van Houten
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MNinnesota; OptumLabs, Cambridge, Massachusetts
| | - Semirra L Bayan
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Karthik Balakrishnan
- Department of Otolaryngology - Head & Neck Surgery, Stanford University, Palo Alto, California
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Patel J, Boon M, Spiegel J, Huntley C. Safety of Outpatient Type 1 Thyroplasty. EAR, NOSE & THROAT JOURNAL 2020; 100:608S-613S. [PMID: 31903781 DOI: 10.1177/0145561319894414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Type 1 thyroplasty is an established procedure for the treatment of vocal fold paralysis to improve voice and swallowing outcomes. At our institution, we commonly perform this procedure on an outpatient basis in medically stable patients. With this study, we assess the safety of outpatient thyroplasty by examining complication and readmission rates, need for revision surgery, and predictors of these outcome measures. METHODS We performed a retrospective review of patients undergoing outpatient type 1 thyroplasty for vocal fold paralysis between 2013 and 2018 at our institution. We documented the etiology of paralysis, comorbidities, and demographic data. Our primary outcome measures were complications, need for readmission, and need for revision surgery. RESULTS During the study period, 160 patients met our inclusion criteria. Mean age at time of surgery was 62.1 ± 13.9 years; there were 82 (51%) males and 78 (49%) females. Nine (5.6%) patients experienced major complications after surgery and 7 (4.4%) patients required unplanned readmission. Mean time to complication was 6.9 ± 9.7 days. There were no instances of postoperative airway compromise requiring intervention. There were no mortalities. Of those who underwent primary surgery, 22 (14%) patients required revision surgery. CONCLUSION Given that complications tend to occur in a delayed fashion rather than in the acute postoperative period, same-day discharge seems reasonable as compared to overnight observation in medically stable patients undergoing type 1 thyroplasty. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jena Patel
- Department of Otolaryngology-Head and Neck Surgery, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Maurits Boon
- Department of Otolaryngology-Head and Neck Surgery, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph Spiegel
- Department of Otolaryngology-Head and Neck Surgery, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Colin Huntley
- Department of Otolaryngology-Head and Neck Surgery, 6559Thomas Jefferson University, Philadelphia, PA, USA
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Medialisation thyroplasty with tensor fascia lata: a novel approach for reducing post-thyroplasty complications. The Journal of Laryngology & Otology 2018; 132:364-367. [PMID: 29463320 DOI: 10.1017/s0022215118000300] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND 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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Abstract
PURPOSE OF REVIEW Laryngeal framework surgery (LFS) is an indispensable surgical approach for the treatment of voice problems. The purpose of this review is to single out some relevant articles published on the topic of LFS from 2015 to mid-2016. Articles referring to injection laryngoplasty (augmentation) are entirely left aside. RECENT FINDINGS In the vast majority of recent publications, LFS mostly addresses surgery intended to improve vocal function in cases of glottic insufficiency. Here, medialization laryngoplasties remain the most important surgery. Arytenoid adduction remains an important technique within this field. Some clinical studies concerning indications and outcome of LFS are covered in the recent articles, trying to improve decision making for the indication of medialization laryngoplasty to enhance the rate of favorable long-term results. As in the past years, only a few articles report on laboratory research and other aspects of LFS. SUMMARY Articles published from 2015 to mid-2016 show that further improvements in LFS have been made, both surgically-technically and in respect of patient selection. There is still a debate about the combination of medialization laryngoplasty and arytenoid adduction in patients with unilateral vocal fold paralysis or paresis (UVFP). Although augmentation laryngoplasties are significantly increasing in number, it seems that LFS remains an important procedure within phonosurgery.
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Shoffel-Havakuk H, Merati AL, Johns MM. Is laryngeal framework surgery safe in the radiated larynx? Laryngoscope 2016; 127:778-780. [PMID: 27861927 DOI: 10.1002/lary.26378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Hagit Shoffel-Havakuk
- USC Voice Center, Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Albert L Merati
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Michael M Johns
- USC Voice Center, Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California
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Kubik M, Rosen C. Laryngeal Framework Surgery in the Irradiated Neck: A Retrospective Matched Cohort Study. Ann Otol Rhinol Laryngol 2016; 125:823-8. [PMID: 27357974 DOI: 10.1177/0003489416656203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Laryngeal framework surgery (LFS) remains a cornerstone treatment in the management of glottic insufficiency. Traditionally, a history of radiation to the neck has been considered a relative contraindication to LFS. METHODS A retrospective matched cohort study was performed to study LFS outcomes in patients with and without a history of radiation. Variables studied included radiation specifics, surgical time, operative difficulty, complications, need for revision surgery, and Voice Handicap Index-10 (VHI-10) scores. RESULTS A total of 298 patients were studied. Fourteen patients with a history of neck irradiation were matched with 14 nonirradiated controls. No complications were encountered in the nonirradiated cohort. In the irradiated cohort, there were 2 minor wound complications and 1 admission for stridor treated medically. No cases of implant extrusion were observed. The VHI-10 scores were improved in both cohorts relative to preoperative baseline (P = .001). Posttreatment VHI-10 scores were better in the nonirradiated cohort (P = .03). There was no difference between cohorts with respect to complication rates, surgical time, surgical difficulty, length of stay, use of a surgical drain, or need for revision surgery. CONCLUSION Laryngeal framework surgery is safe and associated with improved voice outcomes in patients with a history of neck irradiation.
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Affiliation(s)
- Mark Kubik
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Clark Rosen
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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