Our Experience with Thyroplasty Type I

Overview

Medialization of the vocal cord by the method of thyroplasty I is a possible surgicaltreatment of unilateral paresis of the larynx or inadequate closure of the true glottis duringphonation. The authors implemented thyroplasty I as a phonosurgical operation in the modificationof Harries and Morrison in a total of 31 patients. In 23 patients unilateral paresis of the recurrentnerve was involved (14 times after thyroidectomy ogoitrectomy, twice after surgery of a chemodec-toma of the glomus caroticum, once after surgery of neurinoma of the acoustic nerve; five timesidiopathic paresis was involved, probably after a virosis and once paresis of obscure etiology ina female patient with breast cancer). In seven patients the voice was impaired due to atrophy ofa movable vocal cord and in one patient due to ankylosis of the cricoarytenoid articulation.The most frequent preoperative complaints of the surgically treated group of patients were hoarse-ness, vocal fatigue and inadequate expectoration or the feeling of mucus in the airways. Thecomplaint of dyspnoea when speaking was more frequent than dyspnoea during physical exertion.During the postoperative subjective evaluation 25 patients reported substantial regression of theircomplaints, four patients reported improvement of their condition and only two patients reportedthat their condition did not change. The subjective evaluation was in the majority of patientsconsistent with findings of laryngoscopy, the preoperative and postoperative phoniatric examina-tion. The evaluation was less consistent with the change in the length of the maximal phonationtime before and after surgery.In one patient the authors observed a dislocation of the prosthesis from the window in the thyroidcartilage, one female patient complained about the postoperative scar on the neck. The postopera-tive oedema in the laryngeal area did not cause in any of the patients dyspnoea during inspiration.The authors consider thyroplasty I a phonosurgical method which gives great hope of substantialmitigation of complaints in patients with unilateral paresis or atrophy of the vocal cord, whilecomplications and failure of treatment are minimal. Detailed pre- and postoperative phoniatricexamination is an essential part of phonosurgical treatment.

Key words:
phonosurgery, thyroplasty I, medialization of the vocal cord.