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Abstract
Laryngeal framework surgery is an umbrella term for all phonosurgical procedures by which the cartilaginous structure of the larynx and thereby the position and tension of the vocal folds are changed. The aim is to improve the voice. By far the best known and most frequently performed operation is thyroplasty type 1 according to Isshiki, also known as medialization thyroplasty, which is indicated for treatment of glottic insufficiency. Although the first medialization thyroplasty was successfully performed by Payr in Germany in 1915, more than 100 years later, it is still not widely used in Germany.
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Affiliation(s)
- Markus Hess
- Medical Voice Center, Martinistraße 64, 20251, Hamburg, Deutschland.
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Laccourreye O, Rubin F, van Lith-Bijl J, Desuter G. Keys to successful type-1 thyroplasty with Montgomery® implant for unilateral laryngeal immobility in adults. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:191-194. [PMID: 33158759 DOI: 10.1016/j.anorl.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Based on a review of the medical literature, the authors document the key technical points and pitfalls in type I thyroplasty with Montgomery® implant, and the main results and indications in unilateral laryngeal immobility.
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Affiliation(s)
- O Laccourreye
- Service d'otorhinolaryngologie et de chirurgie cervicofaciale, université Paris Centre, HEGP, AP-HP, 20-40, rue Leblanc, 75015 Paris, France.
| | - F Rubin
- Clinique St-Vincent, 8, rue de Paris, CS 71027, 97404 Saint-Denis cedex, La Réunion, France
| | - J van Lith-Bijl
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, cliniques universitaires Saint-Luc, UC Louvain, 10, avenue Hippocrate, 1200 Bruxelles, Belgium
| | - G Desuter
- Service d'otorhinolaryngologie et de chirurgie cervico-faciale, cliniques universitaires Saint-Luc, UC Louvain, 10, avenue Hippocrate, 1200 Bruxelles, Belgium
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Ho GY, Leonhard M, Denk-Linnert DM, Schneider-Stickler B. Pre- and intraoperative acoustic and functional assessment of the novel APrevent ® VOIS implant during routine medialization thyroplasty. Eur Arch Otorhinolaryngol 2019; 277:809-817. [PMID: 31845039 PMCID: PMC7031216 DOI: 10.1007/s00405-019-05756-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/03/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Persistent unilateral vocal fold paralysis (UFVP) with glottal insufficiency often requires type I medialization thyroplasty (MT). Previous implants cannot be adjusted postoperatively if necessary. The newly developed APrevent® VOIS implant (VOIS) can provide postoperative re-adjustment to avoid revision MT. The objective of this pilot study is to evaluate the VOIS intraoperatively concerning voice improvement, surgical feasibility and device handling. METHODS During routine MT, VOIS was applied short time in eight patients before the regular implantation of the Titanium Vocal Fold Medialization Implant (TVFMI™). In all patients, perceptual voice sound analysis using R(oughness)-B(reathiness)-H(oarseness)-scale, measurement of M(aximum)-P(honation)-T(ime) and glottal closure in videolaryngoscopy were performed before and after implanting VOIS/TVFMI™. Acoustic analyses of voice recordings were performed using freeware praat. Surgical feasibility, operative handling and device fitting of VOIS and TVFMI™ were assessed by the surgeon using V(isual)-A(nalog)-S(cale). Data were statistically analyzed with paired t test. RESULT All patients showed significant improvement of voice sound parameters after VOIS/TVFMI™ implantation. The mean RBH-scale improved from preoperative R = 2.1, B = 2.3, H = 2.5 to R = 0.6, B = 0.3, H = 0.8 after VOIS and R = 0.5, B = 0.3, H = 0.8 after TVFMI™ implantation. The mean MPT increased from preoperative 7.9 to 14.6 s after VOIS and 13.8 s after TVFMI™ implantation. VOIS/TVFMI™ achieved complete glottal closure in 7/8 patients. The satisfaction with intraoperative device fitting and device handling of VOIS was as good as that of TVFMI™. CONCLUSION The novel APrevent® VOIS implant showed similar intraoperative voice improvement compared to routinely used TVFMI™ without adverse device events and with safe device fitting.
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Affiliation(s)
- Guan-Yuh Ho
- Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Matthias Leonhard
- Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Doris-Maria Denk-Linnert
- Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Berit Schneider-Stickler
- Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Pflug C, Niessen A, Müller F, Precht C, Nienstedt JC, Hess M. Pin-up Glottoplasty: Feasibility Study of a Novel Approach Medializing or Lateralizing Immobile Vocal Folds. J Voice 2019; 33:162-168. [DOI: 10.1016/j.jvoice.2017.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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Desuter G, Cartiaux O, Pierard J, Henrard S, van Lith-Bijl J, van Benthem PP, Sjögren E. Accuracy of Thyroid Cartilage Fenestration During Montgomery Medialization Thyroplasty. J Voice 2019; 34:609-615. [PMID: 30658874 DOI: 10.1016/j.jvoice.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Accuracy of thyroid cartilage fenestration during Montgomery thyroplasty (MTIS) is considered a key success factor. The primary aim of the study was to retrospectively evaluate the accuracy of fenestration. Furthermore, recent publications indicate a possible discrepancy in MTIS voice outcomes related to gender. The secondary aim of the study was to investigate whether the fenestration accuracy could explain this discrepancy. MATERIAL AND METHOD Study was performed by virtually drawing the fenestration on a 3D CT scan as proposed by the MTIS's instructions for use (the "expected window" (EW)), and comparing it to the actually realized fenestration (the "realized window "(RW)). Four position variables, (a) surface overlap (%), (b) the distances between RW and EW centers (mm), (c) the angle between RW and EW (°), and (d) the orientation of RW's center, were studied and compared to MPT (seconds) and VHI-30 scores outcomes. A descriptive statistical analysis and comparison between males and females were performed using a Mann-Whitney U test. Linear regression and multivariate analysis were also performed. RESULTS The median overlapping surface was 58.8 % [34.6; 75.4]. The median radius was 3.2 mm [1.7; 4.1]. The median angle was 16° [6.8; 21.2]. Results show no significant differences of overlapping surface percentage, distance, or angle by gender. Data show no correlation between voice outcome and percentage overlap, distance, or angle. However, data show better outcomes when fenestration was located in the infero-anterior orientation. All patients of this orientation were males. CONCLUSIONS Data provided by this study advocate a maximal infero-anterior positioning of the window during MTIS. This position is more difficult to obtain in female patients.
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Affiliation(s)
- Gauthier Desuter
- Otolaryngology, Head and Neck Surgery Department, Voice and Swallowing Clinic, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Otolaryngology, Head and Neck Surgery Department, Leidse Universitaire Medisch Centrum (LUMC), University of Leiden, Leiden, The Netherlands.
| | - Olivier Cartiaux
- Neuromusculoskeletal Lab (NMSK), Institut de Recherche Clinique et Expérimentale (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Jonathan Pierard
- Neuromusculoskeletal Lab (NMSK), Institut de Recherche Clinique et Expérimentale (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Séverine Henrard
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, and Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - Julie van Lith-Bijl
- Otolaryngology, Head and Neck Surgery Department, Voice and Swallowing Clinic, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium; Otolaryngology Deparment., Flevoziekenhuis, Almere, The Netherlands
| | - Peter Paul van Benthem
- Otolaryngology, Head and Neck Surgery Department, Leidse Universitaire Medisch Centrum (LUMC), University of Leiden, Leiden, The Netherlands
| | - Elisabeth Sjögren
- Otolaryngology, Head and Neck Surgery Department, Leidse Universitaire Medisch Centrum (LUMC), University of Leiden, Leiden, The Netherlands
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Desuter G, Zapater E, Van der Vorst S, Henrard S, van Lith-Bijl JT, van Benthem PP, Sjögren EV. Very long-term Voice Handicap Index Voice Outcomes after Montgomery Thyroplasty: A cross-sectional study. Clin Otolaryngol 2018; 43:1097-1103. [PMID: 29624876 DOI: 10.1111/coa.13113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this multicentric cross-sectional study was to examine the permanency of Montgomery thyroplasty (MTIS) results from a patient's perspective. DESIGN The study consisted of collecting Voice Handicap Index (VHI-30) questionnaires from patients who had previously been operated with MTIS between 2 and 12 years before. Very long-term (>2 years) postoperative data were compared with the previously acquired preoperative and early postoperative VHI results. Influence of factors such as age, gender, size/side of the prosthesis and length of the follow-up were also analysed. SETTING Multicentric study involving three tertiary European voice centres. PARTICIPANTS Forty-nine unilateral vocal fold paralysis (UVFP) patients, treated by MTIS, were included in the study. MAIN OUTCOME MEASURES The Voice Handicap Index-30 score. RESULTS & CONCLUSIONS The median VHI was significantly different over time-points (Friedman's test P < .001), with a significant difference between preoperative and early postoperative time-points (median VHI: 70 vs 21, respectively; P < .001) and between preoperative and very long-term postoperative time-points (median VHI: 70 vs 16, respectively; P < .001). The median VHI did not differ for the early and very long-term postoperative time-points (median VHI: 21 vs 16; P = .470). Age differences, gender differences and size/side differences of the prostheses, centres where surgery took place and length of the follow-up showed no significant influence. Medialisation thyroplasty (MT) overall and MTIS, in particular, should be considered as a possible standard of care for UVFP when permanency of voice results is sought.
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Affiliation(s)
- G Desuter
- Otolaryngology, Head & Neck Surgery Department, Voice & Swallowing Clinic, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.,Otolaryngology, Head & Neck Surgery Department, LUMC, University of Leiden, Leiden, The Netherlands
| | - E Zapater
- Otolaryngology, Head & Neck Surgery Department, Valencia Medical School, University General Hospital, Valencia, Spain
| | - S Van der Vorst
- Otolaryngology, Head & Neck Surgery Department, Hôpital universitaire UCL Namur, Mont-Godinne, Université catholique de Louvain, Yvoir, Belgium
| | - S Henrard
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - J T van Lith-Bijl
- Otolaryngology, Head & Neck Surgery Department, Voice & Swallowing Clinic, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.,Otolaryngology Department, Flevoziekenhuis, Almere, The Netherlands
| | - P P van Benthem
- Otolaryngology, Head & Neck Surgery Department, LUMC, University of Leiden, Leiden, The Netherlands
| | - E V Sjögren
- Otolaryngology, Head & Neck Surgery Department, LUMC, University of Leiden, Leiden, The Netherlands
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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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Voice outcome indicators for unilateral vocal fold paralysis surgery: a review of the literature. Eur Arch Otorhinolaryngol 2017; 275:459-468. [PMID: 29264655 DOI: 10.1007/s00405-017-4844-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION There is no consensus on which voice outcome indicators (VOIs) should be used to compare the merits of the various surgical treatments for unilateral vocal fold paralysis (UVFP). Authors performed a literature review to identify which VOIs are most frequently used and most relevant, in terms of significant change in pre- and post-operative measurements, to assess UVFP surgical treatments. METHOD A Medline/Pubmed literature review was performed and the most frequently used VOIs were identified using a Pareto diagram. For these most frequently used VOI's, the number of studies that showed a statistically significant change in pre- and post-operative results were compared to the total number of studies found using that same VOI, this portion was expressed in percent. This percentage was defined as the "percentage of significance" and used to assess changes of each VOI. RESULTS Eleven VOIs were identified using the Pareto analysis. These were, in decreasing order of frequency of citation: maximum phonation time (MPT), jitter, Shimmer, video-stroboscopic examination, noise to harmonic ratio (NHR/HNR), mean air flow (MeAF), fundamental frequency (F0), "Infrequent Perceptional Scales", GRBAS scale, mean subglottic pressure (MSGP). MPT, MeAF, factor G of GRBAS-I, Jitter, shimmer and VHI-30 had respective "percentage of significance" of 90, 86, 85, 74, 68 and 64%, respectively. CONCLUSION The results indicate that MPT, MeAF and GRBAS-I, represent the top-three most frequently used and the most relevant VOIs in terms of "percentage of significance". VHI-30 showed a relatively low rate of use and low "percentage of significance". The role of Jitter and Shimmer remains unclear. Finally, MSGP and the F0 appear to be less relevant VOIs for the evaluation of UFVP surgical treatments in terms of significant change in pre- and post-operative measurements.
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Desuter G, Henrard S, Van Lith-Bijl JT, Amory A, Duprez T, van Benthem PP, Sjögren E. Shape of Thyroid Cartilage Influences Outcome of Montgomery Medialization Thyroplasty: A Gender Issue. J Voice 2016; 31:245.e3-245.e8. [PMID: 27769698 DOI: 10.1016/j.jvoice.2016.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to determine whether the shape of the thyroid cartilage and gender influence voice outcomes after a Montgomery thyroplasty implant system (MTIS). METHODS A retrospective cohort study was performed on 20 consecutive patients who underwent MTIS. Voice outcome variables were the relative decrease in Voice Handicap Index (%) and the absolute increase in maximum phonation time (MPT) (in seconds). Material variables were the angle between the thyroid cartilage laminae (α-angle), the size of the prosthesis, and a combination of both (the α-ratio). Continuous variables were analyzed using medians and were compared between groups using the Mann-Whitney U test. Factors associated with the outcome variables were assessed by multivariable linear regression. A Pearson coefficient was calculated between material variables. RESULTS The absolute increase in MPT between the pre- and postoperative period was significantly different between men and women, with a median absolute increase of 11.0 seconds for men and of 1.3 seconds for women (P < 0.001). A strong inverse correlation between the α-ratio and the absolute increase in MPT is observed in all patients, with a Pearson correlation coefficient R = -0.769 (P < 0.001). No factors were significantly associated with the relative Voice Handicap Index decrease in univariable or multivariable analyses. A better Pearson coefficient between the α-angle and the prosthesis size was found for females (0.8 vs 0.71). CONCLUSION The MTIS is a good thyroplasty modality for male patients, but inadequate design of MTIS female implants leads to poor MPT outcomes. This represents a gender issue that needs to be further studied and eventually tackled.
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Affiliation(s)
- Gauthier Desuter
- Otolaryngology Head and Neck Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
| | - Sylvie Henrard
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | | | - Avigaëlle Amory
- Otolaryngology Head and Neck Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Thierry Duprez
- Radiology Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Peter Paul van Benthem
- Otolaryngology Head and Neck Surgery Department, LUMC, University of Leiden, Leiden, The Netherlands
| | - Elisabeth Sjögren
- Otolaryngology Head and Neck Surgery Department, LUMC, University of Leiden, Leiden, The Netherlands
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Dziegielewski PT, Kang SY, Ozer E. Transoral robotic surgery (TORS) for laryngeal and hypopharyngeal cancers. J Surg Oncol 2015; 112:702-6. [PMID: 26266762 DOI: 10.1002/jso.24002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/22/2015] [Indexed: 11/11/2022]
Abstract
Transoral robotic surgery (TORS) is increasingly used in laryngeal/hypopharyngeal cancer surgery. Ablative procedures described in these anatomical sites include: (i) supraglottic laryngectomy, (ii) total laryngectomy, (iii) glottic cordectomy, and (iv) partial pharyngectomy. TORS supraglottic laryngectomy remains the most commonly performed of these procedures. Initial oncologic and functional outcomes with these procedures are promising and comparable to other treatment options. As robotic instrumentation technology advances a rise in TORS laryngeal/hypopharyngeal surgery is anticipated.
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Affiliation(s)
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
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