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Konjević B, Košec A, Peček M, Stevanović S. Management of Implant Extrusion following Thyroplasty for Vocal Fold Paralysis: A Case Report. ORL J Otorhinolaryngol Relat Spec 2023; 86:50-53. [PMID: 37820602 DOI: 10.1159/000533812] [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: 11/28/2022] [Accepted: 08/21/2023] [Indexed: 10/13/2023]
Abstract
The most widely used laryngeal surgery technique for patients with vocal fold paralysis is medialization thyroplasty. Materials such as Gore-Tex, silastic, and hydroxyapatite are often used, and the most worrisome possible complication is extrusion of the implant. A 36-year-old female patient with a history of pediatric cardiac surgery was diagnosed with left vocal cord paralysis after an episode of upper respiratory infection with a working diagnosis of subclinical left vocal cord paralysis following cardiac surgery. She underwent medialization thyroplasty with a Gore-Tex implant under local anesthesia. On the 21st postoperative day, she presented with sudden-onset hoarseness and dysphagia due to Gore-Tex implant extrusion. The implant was removed and augmentation of the left vocal cord with adipose tissue was performed. Only 14 cases of Gore-Tex implant extrusion have been described in the literature so far. The aim of this case report was not only to show one possible complication when using a Gore-Tex implant but also to present fat augmentation as one of the solutions for revision medialization and salvage treatment, with sustained long-term results.
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Affiliation(s)
- Barbara Konjević
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Andro Košec
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Mirta Peček
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Siniša Stevanović
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
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Frost A, Mirza N. Gore-Tex implant extrusion following revision medialization thyroplasty: Case report and review of the literature. World J Otorhinolaryngol Head Neck Surg 2020; 8:S2095-8811(20)30106-2. [PMID: 32983585 PMCID: PMC7502009 DOI: 10.1016/j.wjorl.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/16/2020] [Accepted: 08/19/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To review current literature and experience with Gore-TexⓇ implant extrusion following medialization thyroplasty, as well as to report the unique case of Gore-TexⓇ implant extrusion following revision medialization thyroplasty. METHODS Review of existing literature and description of personal experience with unique case of Gore-TexⓇ implant extrusion following revision medialization thyroplasty. RESULTS Review of existing literature found no prior reported cases of Gore-TexⓇ implant extrusion following revision medialization thyroplasty. Risk factors for implant extrusion include the pressure of the implant on insertion and the inability to secure the implant. Cases of implant extrusion can be managed operatively via an endoscopic or via an external open approach. CONCLUSION This is the first reported case of Gore-TexⓇ implant extrusion following revision medialization thyroplasty. Careful consideration should be given in revision medialization thyroplasty as additional implant material may cause increased pressure, a risk factor for implant extrusion.
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Affiliation(s)
- Ariel Frost
- Department of Otorhinolaryngology ‐ Head & Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Natasha Mirza
- Department of Otorhinolaryngology ‐ Head & Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPAUSA
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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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Mattioli F, Bettini M, Botti C, Busi G, Tassi S, Malagoli A, Molteni G, Trebbi M, Luppi MP, Bergamini G, Presutti L. Polydimethylsiloxane Injection Laryngoplasty for Unilateral Vocal Fold Paralysis: Long-Term Results. J Voice 2017; 31:517.e1-517.e7. [PMID: 28131460 DOI: 10.1016/j.jvoice.2016.12.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 12/26/2016] [Accepted: 12/28/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To analyze the long-term objective, perceptive, and subjective outcomes after endoscopic polydimethylsiloxane (PDMS) injection laryngoplasty in unilateral vocal fold paralysis. STUDY DESIGN A retrospective study carried out between January 2008 and January 2012. SETTING Head and Neck Department, University Hospital of Modena, Modena, Italy. METHODS This was a retrospective analysis of 26 patients with unilateral vocal fold paralysis who underwent endoscopic injection of PDMS under general anesthesia. A voice evaluation protocol was performed for all patients, which included videolaryngostroboscopy, maximum phonation time, fundamental frequency, analysis of the harmonic structure of the vowel /a/ and the word /aiuole/, Grade of Dysphonia, Instability, Roughness, Breathiness, Asthenia, and Strain scale, and Voice Handicap Index. The protocol was performed before surgery, in the immediate postoperative period, and at least 3 years after surgery. The mean follow-up period was 73 months (range 39-119 months). RESULTS The statistical analysis showed a significant improvement (P < 0.01) for all of the objective, perceptive, and subjective parameters by comparison between the preoperative and long-term follow-up data; moreover, no statistically significant difference was found between the postoperative and long-term follow-up data. This indicates that injection laryngoplasty with PDMS guarantees long-lasting effects over time. No complications were reported in our series. CONCLUSION Injection laryngoplasty with PDMS can be considered to be a minimally invasive and safe technique for the treatment of unilateral vocal fold paralysis. Moreover, it allows very good and stable results to be obtained over time, avoiding repeated treatments and improving the quality of life of the patients.
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Affiliation(s)
| | | | - Cecilia Botti
- Head and Neck Department, University Hospital of Modena, Modena, Italy.
| | - Giulia Busi
- Head and Neck Department, University Hospital of Modena, Modena, Italy
| | - Sauro Tassi
- Head and Neck Department, University Hospital of Modena, Modena, Italy
| | - Andrea Malagoli
- Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena, Modena, Italy
| | - Gabriele Molteni
- Head and Neck Department, University Hospital of Modena, Modena, Italy
| | - Marco Trebbi
- Head and Neck Department, University Hospital of Modena, Modena, Italy
| | - Maria Pia Luppi
- Speech Therapist in Head and Neck Department, University Hospital of Modena, Modena, Italy
| | | | - Livio Presutti
- Head and Neck Department, University Hospital of Modena, Modena, Italy
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One hundred years of external approach medialisation thyroplasty. The Journal of Laryngology & Otology 2017; 131:202-208. [DOI: 10.1017/s0022215116010033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIt has been 100 years since Erwin Payr first developed an operation to improve the effects of a paralysed vocal fold, and operations based on this technique are still in use today. This technique, medialisation thyroplasty, aims to improve the symptoms caused by vocal fold palsy by realigning the lateralised vocal fold into the midline.Whilst the effects of vocal fold palsy were recognised in antiquity, it was only with the development of indirect laryngoscopy in the late nineteenth century that the vocal fold paralysis could be identified as an aetiology for poor phonation and dysphagia. Payr, in 1915, was the first to perform a recognisable form of medialisation thyroplasty, which was further developed in the early twentieth century, but medialisation thyroplasty did not begin to be widely used until the development of the modern technique by Isshiki et al., in 1974.Since then, medialisation thyroplasty has continued to be developed and is currently the most widely used technique for correcting the effects of vocal fold palsy. However, a wide array of therapeutic options is now available for vocal fold palsy and it is impossible to say whether or not medialisation thyroplasty will still be used in another 100 years.
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Sittel C, Echternach M, Federspil PA, Plinkert PK. Polydimethylsiloxane Particles for Permanent Injection Laryngoplasty. Ann Otol Rhinol Laryngol 2016; 115:103-9. [PMID: 16514791 DOI: 10.1177/000348940611500204] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Polydimethylsiloxane (PDMS) particles are a nonresorbable material that allows for permanent vocal fold augmentation. This study investigated morbidity and voice quality in patients treated for unilateral vocal fold paralysis by injection of PDMS particles. Methods: Fourteen patients who had neurogenic unilateral vocal fold paralysis of different causes were included in this prospective study. Each patient underwent videostroboscopic assessment before and after operation. Friedrich's dysphonia index (DI), a score system combining subjective and objective parameters, was used to describe voice quality. A DI of 0 reflects a normal voice, and a DI of 3 stands for complete aphonia. The PDMS particles were injected into the paraglottic space by microlaryngoscopy under general anesthesia. Results: The median follow-up was 4.1 months. There was no complication attributable to the injection of PDMS particles. The mean DI was 2.8 before operation. After the operation, voice quality improved significantly in each patient, as reflected by a mean postinjection DI of 1.4. Conclusions: Particles of PDMS provide a relatively safe and minimally invasive option for permanent vocal fold augmentation. The functional results in terms of voice improvement are comparable to those obtained with other techniques, including thyroplasty. In the European Community, PDMS particles are officially approved for use in the human larynx.
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Affiliation(s)
- Christian Sittel
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Heidelberg, Heidelberg, Germany
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Wong BYH, Yu SY, Ho WK, Wei WI, Ng ML. Injection laryngoplasty using hyaluronic acid for Chinese patients with unilateral vocal fold paralysis. SPEECH LANGUAGE AND HEARING 2016. [DOI: 10.1080/2050571x.2016.1159407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kodama H, Kumai Y, Nishimoto K, Sanuki T, Yumoto E. Modulation of satellite cells activity and MyoD in rat thyroarytenoid muscle after reinnervation. Laryngoscope 2015; 125:E245-51. [PMID: 25809587 DOI: 10.1002/lary.25248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 01/14/2015] [Accepted: 02/12/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS To examine modulation of M-cadherin, a marker for satellite cells (SCs); and MyoD, which may indicate the myogenic activity following recurrent laryngeal nerve (RLN) denervation and immediate reinnervation; and to elucidate the correlation between their modulations and establishment of neuromuscular junctions (NMJs) in the reinnervated rat thyroarytenoid (TA) muscle. STUDY DESIGN Quantitative real-time polymerase chain reaction qPCR and histologic assessment of the TA muscle following RLN transection and anastomosis. METHODS Rats were divided into three groups: 1) denervation alone (DNV) (n = 60), 2) denervation with anastomosis (ANS) (n = 60), and 3) sham-operated controls (n = 12). Animals were sacrificed at 3 days and 1, 3, and 5 weeks after treatment. TA muscles harvested from 40 animals from each DNV and ANS group; all of sham group were subjected to qPCR for assessment of the modulation of M-cadherin and MyoD; and the remaining larynges of DNV and ANS group were used for histologic analysis. RESULTS The expression levels of messenger RNAs (mRNAs) encoding M-cadherin and MyoD in the TA muscle of the DNV group were significantly higher (P < 0.05) than in the control throughout the study period. These mRNA levels in the ANS group were significantly higher (P < 0.05) at ≤ 1 week than in the controls but fell to control levels at ≥ 3 weeks. In the ANS group, recovery of muscle area and NMJs structure occurred by 3 weeks. CONCLUSION These data suggested that NMJ formation following reinnervation might prompt recovery of M-cadherin and MyoD mRNA expression to the quiescent level of SCs.
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Affiliation(s)
- Haruka Kodama
- Department of Otolaryngology Head and Neck Surgery, Kumamoto University, Graduate School of Medicine, Kumamoto, Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology Head and Neck Surgery, Kumamoto University, Graduate School of Medicine, Kumamoto, Japan
| | - Kohei Nishimoto
- Department of Otolaryngology Head and Neck Surgery, Kumamoto University, Graduate School of Medicine, Kumamoto, Japan
| | - Tetsuji Sanuki
- Department of Otolaryngology Head and Neck Surgery, Kumamoto University, Graduate School of Medicine, Kumamoto, Japan
| | - Eiji Yumoto
- Department of Otolaryngology Head and Neck Surgery, Kumamoto University, Graduate School of Medicine, Kumamoto, Japan
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Seyed Toutounchi SJ, Eydi M, Golzari SE, Ghaffari MR, Parvizian N. Vocal cord paralysis and its etiologies: a prospective study. J Cardiovasc Thorac Res 2014; 6:47-50. [PMID: 24753832 PMCID: PMC3992732 DOI: 10.5681/jcvtr.2014.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 01/10/2014] [Indexed: 01/02/2023] Open
Abstract
Introduction:
Vocal cord paralysis is a common symptom of numerous diseases and it may be due to neurogenic or mechanical fixation of
the cords. Paralysis of the vocal cords is just a symptom of underlying disease in some cases; so, clinical diagnosis of the underlying
cause leading to paralysis of the vocal cords is important. This study evaluates the causes of vocal cord paralysis.
Methods: In a prospective study, 45 patients with paralyzed vocal cord diagnosis were examined by tests such as examination of the pharynx, larynx,
esophagus, thyroid, cervical, lung, and mediastinum, brain and heart by diagnostic imaging to investigate the cause vocal cord paralysis.
The study was ended by diagnosing the reason of vocal cord paralysis at each stage of the examination and the clinical studies.
Results: The mean duration of symptoms was 18.95±6.50 months. The reason for referral was phonation changes (97.8%) and aspiration (37.8%)
in the subjects. There was bilateral paralysis in 6.82%, left paralysis in 56.82% and right in 63.36% of subjects. The type of vocal cord
placement was midline in 52.8%, paramedian in 44.4% and lateral in 2.8% of the subjects. The causes of vocal cords paralysis were
idiopathic paralysis (31.11%), tumors (31.11%), surgery (28.89%), trauma, brain problems, systemic disease and other causes (2.2%).
Conclusion: An integrated diagnostic and treatment program is necessary for patients with vocal cord paralysis. Possibility of malignancy should be excluded before marking idiopathic reason to vocal cord paralysis.
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Affiliation(s)
| | - Mahmood Eydi
- Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samad Ej Golzari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Nashmil Parvizian
- Department of ENT, Tabriz University of Medical Sciences, Tabriz, Iran
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Kupfer RA, Meyer TK. Evaluation of Unilateral Vocal Fold Immobility. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014. [DOI: 10.1007/s40136-014-0043-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Thakar A, Sikka K, Verma R, Preetam C. Cricothyroid approximation for voice and swallowing rehabilitation of high vagal paralysis secondary to skull base neoplasms. Eur Arch Otorhinolaryngol 2011; 268:1611-6. [PMID: 21739100 DOI: 10.1007/s00405-011-1614-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Accepted: 04/14/2011] [Indexed: 11/26/2022]
Abstract
This study documents the speech and swallowing outcomes of isolated ipsilateral cricothyroid approximation (aka tensioning thyroplasty; Type IV thyroplasty) for the treatment of high vagal paralysis (combined superior laryngeal nerve and recurrent laryngeal nerve paralysis). This is a pilot study of five cases with high vagal paralysis consequent to skull base neoplasms. Unilateral cricothyroid tensioning sutures were used. In all cases, vocal fold tensioning and vertical realignment of lax vocal folds were achieved. A partial, but acceptable medialization of vocal cord position was achieved. In all cases, aspiration was minimized and normal swallow function was restored by 6 weeks. The voice outcome was excellent in four cases and acceptable in one. Cricothyroid approximation restores vocal fold tension; in addition, it restores vertical vocal fold position and partially restores horizontal vocal fold position. Good voice and swallowing outcomes have been achieved. The procedure is quick, safe, and convenient when combined with a skull-base excision procedure. Further evaluation is merited.
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Affiliation(s)
- Alok Thakar
- Department of Otolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Abstract
Thyroplasty is an operation on the upper airway to improve voice quality in patients with unilateral vocal cord paralysis. It is a difficult anaesthetic procedure that requires sharing the airway with the surgeon. We describe a good anaesthetic technique, which provides a safe airway with excellent operating conditions, using continuous cervical epidural anaesthesia and postoperative analgesia in three patients. The use of a regional anaesthetic technique provides excellent anaesthesia and analgesia while allowing the patient to phonate at the request of the surgeon intraoperatively.
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Affiliation(s)
- Vandana Trivedi
- Professor Anaesthesia, M. P. Shah Medical College, Jamnagar - 361 008, Gujarat, India
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Therapy of unilateral vocal fold paralysis with polydimethylsiloxane injection laryngoplasty: our experience. J Voice 2009; 24:119-25. [PMID: 19185462 DOI: 10.1016/j.jvoice.2008.05.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 05/07/2008] [Indexed: 11/20/2022]
Abstract
The objective of this study was to document functional results and to compare objective and subjective voice measures after endoscopic laryngoplasty with injection of polydimethylsiloxane (PDMS) for the treatment of unilateral vocal fold paralysis, and to verify PDMS biocompatibility in vocal fold. The design used was a longitudinal prospective study. Fifteen patients with unilateral vocal fold paralysis underwent endoscopic injection of PDMS in general anesthesia. Accurate voice evaluation protocol (acoustic and aerodynamics analyses, GIRBAS [Grade, Instability, Roughness, Breathiness, Asthenia, and Strain] scale, videostrobolaryngoscopy, and Voice Handicap Index test) before, after surgery, and at follow-up time was performed. The median follow-up was 21.7 months (range, 6-35). Data obtained were statistically significant. All acoustic, aerodynamics, perceptive, and subjective evaluations showed a significant improvement. No complications due to PDMS were reported. Functional results were found comparable to framework surgery. Endoscopic injection laryngoplasty with PDMS is a safe and long-term option for treatment of unilateral vocal fold paralysis.
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Dursun G, Boynukalin S, Bagis Ozgursoy O, Coruh I. Long-term results of different treatment modalities for glottic insufficiency. Am J Otolaryngol 2008; 29:7-12. [PMID: 18061825 DOI: 10.1016/j.amjoto.2006.12.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 12/05/2006] [Accepted: 12/13/2006] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to investigate the early and long-term functional results of thyroplasty type-I and injection laryngoplasty using fat or calcium hydroxylapatite. MATERIALS AND METHODS Thirty patients with glottic insufficiency were included and followed up between 1-7 years. Patients with glottic bowing or sulcus vocalis were selected for injection augmentation of the vocal folds, while those with unilateral vocal fold immobility underwent medialization thyroplasty. Perceptual and acoustic analysis of voice, and videolaryngostroboscopy were performed before and after surgery. RESULTS After the surgery, GRBAS scale of all patients demonstrated significant change in grade of severity, roughness, and breathiness. Acoustic analysis demonstrated significant change in Fo, jitter, shimmer, noise to harmonic ratio, and maximum phonation time (MPT) in thyroplasty group, while those demonstrated significant change in Fo (lowest) and jitter, and MPT in injection augmentation group. CONCLUSIONS Medialization thyroplasty is the gold standard for the management of glottic insufficiency, regardless of the severity of glottic gap. However, injection augmentation of the vocal folds may be considered as an alternative in the treatment of patients with small glottic gap. Further studies with larger groups and long follow-up periods are required to figure out the proper material for injection laryngoplasty.
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Abstract
Diagnosis and treatment of the immobile or hypomobile vocal fold are challenging for the otolaryngologist. True paralysis and paresis result from vocal fold denervation secondary to injury to the laryngeal or vagus nerve. Vocal fold paresis or paralysis may be unilateral or bilateral, central or peripheral, and it may involve the recurrent laryngeal nerve, superior laryngeal nerve, or both. The physician's first responsibility in any case of vocal fold paresis or paralysis is to confirm the diagnosis and be certain that the laryngeal motion impairment is not caused by arytenoid cartilage dislocation or subluxation, cricoarytenoid arthritis or ankylosis, neoplasm, or other mechanical causes. Strobovideolaryngoscopy, endoscopy, radiologic and laboratory studies, and electromyography are all useful diagnostic tools.
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Affiliation(s)
- Adam D Rubin
- Lakeshore Professional Voice Center, Lakeshore Ear Nose and Throat Center, 21000 East 12 Mile, Suite 111, St. Clair Shores, MI 48081, USA
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Affiliation(s)
- Hans F Mahieu
- Department of Otolaryngology/Head and Neck Surgery, Vrije Universiteit Medisch Centrum, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands.
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Kelchner LN, Stemple JC, Gerdeman E, Le Borgne W, Adam S. Etiology, pathophysiology, treatment choices, and voice results for unilateral adductor vocal fold paralysis: a 3-year retrospective. J Voice 1999; 13:592-601. [PMID: 10622524 DOI: 10.1016/s0892-1997(99)80013-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Unilateral vocal fold paralysis is now considered a common disorder seen in the practice of otolaryngology and voice pathology. Concern first is for the accurate diagnosis of the associated etiology in an efficient and thorough fashion. When etiology has been determined the focus of treatment becomes the management of the presenting symptoms, which typically include dysphonia and dysphagia. A retrospective study was conducted reviewing the records of 117 patients with unilateral adductor vocal fold paralysis who presented to a large otolaryngology practice and clinical voice lab from 1995 to 1998. Demographic data reveal most patients to range in age from 16 to 91 with a dominant clustering for ages 50 to 70. Gender distribution reveals males slightly exceed females in this sample. Data regarding etiology type are collected in great detail, revealing that disease and surgery involving the chest contribute the greatest to the overall number in this study and that anterior approach to cervical spine surgery contributes as much as thyroid surgery. General outcomes of the patients are reviewed. A small group (n = 25) of patients who had pretreatment and posttreatment data available revealed statistically significant differences between voice outcomes for patients who were treated with medialization and for those treated with therapy. Patients receiving therapy had less severe symptoms pretreatment, while greater gains pretreatment to posttreatment were shown for those who had surgical medialization.
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Affiliation(s)
- L N Kelchner
- Blaine Block Institute for Voice Analysis and Rehabilitation, University of Cincinnati, Ohio 45402, USA
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18
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Grundler S, Stacey MR. Thyroplasty under general anesthesia using a laryngeal mask airway and fibreoptic bronchoscope. Can J Anaesth 1999; 46:460-3. [PMID: 10349925 DOI: 10.1007/bf03012945] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To report the management of a patient, with unilateral vocal cord paralysis, undergoing thyroplasty, under general anesthesia. CLINICAL FEATURES A 25-yr-old man developed hoarseness and occasional episodes of pulmonary aspiration, caused by unilateral vocal cord paralysis. He was scheduled for thyroplasty, in an attempt to ease phonation and to decrease or prevent further episodes of pulmonary aspiration. He refused local anesthesia with sedation and it was therefore decided to attempt the procedure under general anesthesia. The paralysed vocal cord was displaced inwards by a wedge inserted through a window in the thyroid cartilage. We assessed the ideal position of the wedge by using a fibreoptic bronchoscope and laryngeal mask airway during general anesthesia, instead of phonation. CONCLUSION We describe the successful use of a general anesthetic for a thyroplasty, a procedure normally done under local anesthesia with or without sedation, in a patient who was keen to have surgery, but who refused local anesthesia with sedation.
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Affiliation(s)
- S Grundler
- Department of Anesthesia, Heath Hospital NHS Trust, Cardiff, Wales.
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