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Type 1 thyroplasty with arytenoid adduction. To learn more about the Department of Otorhinolaryngology at Mayo Clinic, visit http://mayocl.in/2FDUHTI
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Type 1 thyroplasty with arytenoid adduction – YouTube
Please be advised that this veo contains graphic footage of surgery.Type 1 thyroplasty with aryteno adduction.
Source: www.youtube.com
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Modified Type I Thyroplasty – YouTube
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Type 1 Thyroplasty – Silastic – CSurgeries
Watch a veo of a live Type 1 Thyroplasty – Silastic procedure in addition to hundreds more peer-reviewed surgical veo journals – only at CSurgeries.com.
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Laryngology 101 – Medialization Laryngoplasty | voicedoctor.net
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Type I thyroplasty – JaypeeDigital
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medialization thyroplasty for vocal cord paralysis
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Voice-Surgery-Videos
Surgery: Type I Thyroplasty using Gore-Tex Implant … The veos show a patients vocal folds before surgery, the surgical procedure, and the vocal folds …
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Laryngeal Recovery Following Type I Thyroplasty | Dermatology
Conclusions Thyroplasty is an effective procedure in correcting incomplete glottal … Recovery from postoperative vocal-fold irritation occurs raply, …
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Thyroplasty
A thyroplasty is a procedure performed to help correct vocal … This can be caused from trauma, surgery, … taken to the Recovery Room for observation.
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주제와 관련된 이미지 thyroplasty surgery video
주제와 관련된 더 많은 사진을 참조하십시오 Type 1 thyroplasty with arytenoid adduction. 댓글에서 더 많은 관련 이미지를 보거나 필요한 경우 더 많은 관련 기사를 볼 수 있습니다.
주제에 대한 기사 평가 thyroplasty surgery video
- Author: Mayo Clinic
- Views: 조회수 22,085회
- Likes: 좋아요 155개
- Date Published: 2018. 3. 8.
- Video Url link: https://www.youtube.com/watch?v=eqgYUr_8a_o
How is thyroplasty done?
Thyroplasty is performed in the operating room with the patient asleep during parts of the surgery. A small cut is made on the neck and the voice box is identified. Through a small hole made in the voice box a Gore-Tex implant is placed to move the vocal cord into the proper position.
Is thyroplasty permanent?
Thyroplasty is considered a “permanent” medialization, whereas fat injection is considered “temporary” because of reabsorption.
How long does it take to recover from thyroplasty?
This surgery will usually require a one-night stay in the hospital and full recovery takes about one week. Patients usually enjoy a significant improvement in function and quality of life.
Is thyroplasty safe?
Revision surgery and thyroplasty combined with arytenoid repositioning maneuvers were associated with increased risk of major complications. Conclusions: In general, TP is a safe procedure, with a major complication rate that is lower than that of outpatient thyroidectomy.
How effective is thyroplasty?
In the postoperative questionnaire, 70% of the patients judged their voice as excellent and the remaining patients as improved to good or fair. Conclusions: Type II thyroplasty is a highly effective therapy for AdSD. The voice in AdSD may roughly be classified into strangulated, tremulous, and interrupted types.
What is the purpose of a thyroplasty?
Medialization laryngoplasty (formerly known as thyroplasty) is a surgical treatment for vocal cord paralysis. Your surgeon places an implant into your paralyzed or weak vocal cord. The implant moves a nonfunctioning vocal cord toward the functioning one to allow for better voicing.
How much does thyroplasty cost?
Cost of medialization thyroplasty was C$2499.10 per patient whereas those treated with injection laryngoplasty cost C$943.19.
Can thyroplasty be reversed?
The results of a thyroplasty are permanent but are reversible by the removal of the implant. In some cases, a second surgery may be necessary if the implants need to be repositioned. Patients are usually sent home a day after the procedure and are advised to avoid strenuous activities for about a week.
Does thyroplasty affect singing?
After thyroplasty, long-term results allowed for a self-adjustment or the relearning of more natural breath support patterns consistent with improved vocal cord adduction and glottis closure, thereby allowing for reduced vocal effort and a corresponding decrease in overall habitual voice intensity.
Will my voice change after vocal cord surgery?
Your throat may feel sore or slightly swollen for 2 to 5 days. You may sound hoarse for 1 to 8 weeks, depending on what was done during the procedure. Your doctor may ask you to speak as little as you can for 1 to 2 weeks after the procedure. If you speak, use your normal tone of voice and do not talk for very long.
Can vocal cord surgery change your voice?
Voice feminization surgery raises the pitch of your voice, making it sound higher. The procedure changes the length, tightness or size of your vocal cords. Transgender women may choose to have voice change surgery as part of their male-to-female (MTF) transition.
How successful is vocal cord surgery?
The surgery is performed with local anesthesia, so that the doctor can talk with the patient, get his or her feedback and make adjustments to correct the voice. “Laryngeal framework surgery is very effective,” Dr. Young says. “About 90 percent of people benefit from restored function of their voice.”
Can you lose your voice forever?
Occasional vocal cord injury usually heals on its own. However, those who chronically overuse or misuse their voices run the risk of doing permanent damage, says voice care specialist Claudio Milstein, PhD.
What is a Type 1 thyroplasty?
Type 1 thyroplasty, first described by Isshiki et al in 1975, is an established procedure for the treatment of vocal fold paralysis to improve voice and swallowing outcomes.
How long do vocal cord implants last?
Long-term injections: These are similar to temporary injections, but the injection of a filler is designed to last one year or longer. Permanent implants: If return of vocal cord function is not expected for the patient, a permanent medialization may be desired.
Is thyroplasty reversible?
The results of a thyroplasty are permanent but are reversible by the removal of the implant. In some cases, a second surgery may be necessary if the implants need to be repositioned. Patients are usually sent home a day after the procedure and are advised to avoid strenuous activities for about a week.
How much does thyroplasty cost?
Cost of medialization thyroplasty was C$2499.10 per patient whereas those treated with injection laryngoplasty cost C$943.19.
What is a Type 1 thyroplasty?
Type 1 thyroplasty, first described by Isshiki et al in 1975, is an established procedure for the treatment of vocal fold paralysis to improve voice and swallowing outcomes.
Can you speak after Cordectomy?
Following a total cordectomy, during which all of the vocal cords are removed, the patient will likely be unable to produce most vocal sounds. However, patients almost always can speak in whispers following these procedures.
Featured Video: Thyroplasty for Vocal Cord Paralysis
Presented by Dr. James DuCanto, M.D., Aurora St. Luke’s Medical Center.
The laryngeal framework surgery (LFS) is the surgery of choice for dysphonias resulting from incomplete glottic closure or inadequate vocal fold tension. The medialization (Type I) thyroplasty is most commonly performed for a unilateral vocal cord (VC) paralysis, as in the presented patient. It does not involve surgery on the VC per se, thus avoiding the possibility of scarring and voice aggravation.
The presented video outlines the important steps of the procedure. Both surgical approaches and anesthetic techniques differ, however. Some surgeons perform the procedure “blindly”, relying on the perceived improvement of the voice quality by the patient intraoperatively. Others, as in this video, like to confirm this subjective improvement by visualizing the improved position of the VC. Yet, others elect to perform this surgery under general anesthesia.
Please share your thoughts on the video and the practice of thyroplasty in your institution. What anesthetic techniques do you favor? What special anesthetic considerations may apply to these patients should they require general endotracheal anesthesia in the future?
UC Irvine Medical Center
Thyroplasty
Thyroplasty is a procedure performed to change the position of the vocal cord. This is usually performed to improve a patient’s voice and ability to cough.
Thyroplasty is performed in the operating room with the patient asleep during parts of the surgery. A small cut is made on the neck and the voice box is identified. Through a small hole made in the voice box a Gore-Tex implant is placed to move the vocal cord into the proper position. During the surgery the patient is awoken and asked to speak in an effort to “fine tune” the voice box.
Patients typically stay one night in the hospital after surgery.
Risks of surgery include, but are not limited to:
Pain – Soreness in the neck is common after surgery.
Hoarseness – Worsening of the voice may occur in rare circumstances.
Infection – This is very uncommon and is treated with antibiotics or surgery in rare cases.
Difficulty swallowing – While rare, this may be temporary or permanent.
Bleeding – The chance of bleeding is rare, and bleeding typically stops on its own.
Numbness of the skin and neck usually return to normal within a few months but can be permanent.
Difficulty breathing – This can occur due to swelling after surgery. When severe this requires immediate attention.
Risks of anesthesia are very rare, but include stroke, heart attack, and death.
Instructions after surgery:
You will be observed overnight to monitor the incision, provide antibiotics, and ensure that you do not have trouble breathing.
You will wake up with a bandage around your neck. Please do not manipulate the bandage.
It is OK and encouraged to get out of bed the night of the surgery. You may walk with assistance and use the bathroom normally.
Voice rest – For the first three days after surgery (including the day of surgery) do not use your voice. This means no talking, whispering, or laughing. Avoid coughing if possible. To communicate please have ready a whiteboard with marker and eraser, a pad of paper, or a phone/computer for texting and emailing. After three days moderate voice use is OK. This means no excessive talking, yelling, or phone use. After a week normal voice use is OK.
Diet – Start with liquids and proceed to a normal diet as tolerated.
The day after surgery a physician remove the bandages. If everything looks OK you will be discharged home.
Medication – Pain medicine will be given to you. It should be taken as directed. Side effects may include drowsiness, or nausea and vomiting. Occasionally patients become constipated with this medication. If this occurs, over the counter Colace can be taken.
Incision care – You will notice small band-aid like stickers on the skin. It is important to leave these alone. Do not wet the neck for three days after surgery. After this you may allow a small amount of water on the neck during shower. After about one week the bandages will begin to fall off on their own. This is OK. You may cut off any portion of the bandage that no longer sticks to the skin.
If the neck becomes swollen, red, or tender please call the physician immediately.
For the first two weeks after surgery please do not exert yourself by running or lifting objects over 15 pounds. Walking is OK during this time.
If shortness of breath, difficulty breathing, bleeding, or a fever occurs it is important to visit the emergency room or call 9-1-1 to be transported.
Follow up – The first visit is in our office one week after surgery.
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Thyroplasty
There are many different reasons for vocal cord paralysis. Some of the common causes are surgical injury to the recurrent laryngeal nerve (the nerve that provides movement for the vocal cord), cancers of the larynx (voice box) or the lungs, viruses, strokes, neck trauma, thyroid cancer, or traumatic placement of an endotracheal tube. Depending on the cause of the vocal cord paralysis, it may be temporary or permanent. In addition, there may only be a partial weakening of the vocal cord. In this instance, it is referred to as vocal cord paresis.
Vocal cord paralysis usually presents as hoarseness, a weak or breathy voice, or some coughing and choking while drinking thin liquids like water. Because the two vocal cords cannot adequately close during swallowing, patients are at risk of aspiration, where swallowed foods and/or liquids enter the trachea. This can lead to pneumonia. Patients with vocal cord paralysis will often complain of “running out of air,” especially during conversation.
It can take up to twelve months to determine if a vocal cord paralysis is permanent. During this time, patients can be quite disabled, and the symptoms can adversely affect their work and quality of life. Patients sometimes derive benefit from voice therapy, but this may be time consuming and not achieve the desired voice. For patients who want to try a conservative approach in the hopes that the paralyzed vocal cord will regain normal function, a vocal cord injection can be done to bulk up the paralyzed vocal cord. The injection lasts for several months up to a year and can be repeated if necessary.
If the vocal cord paralysis is deemed permanent, your surgeon at Suburban Ear, Nose, and Throat can perform a definitive surgical procedure to rehabilitate the voice. This procedure is called a medialization thyroplasty. The surgery is done under twilight anesthesia, and the technique involves making an incision in the skin of the neck and then cutting a small window into the larynx. Then, a permanent implant is placed to medialize (push inward) on the paralyzed vocal cord so that it can touch the other vocal cord during speech and swallowing. This surgery will usually require a one-night stay in the hospital and full recovery takes about one week. Patients usually enjoy a significant improvement in function and quality of life.
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Your access to the NCBI website at www.ncbi.nlm.nih.gov has been temporarily blocked due to a possible misuse/abuse situation involving your site. This is not an indication of a security issue such as a virus or attack. It could be something as simple as a run away script or learning how to better use E-utilities, http://www.ncbi.nlm.nih.gov/books/NBK25497/, for more efficient work such that your work does not impact the ability of other researchers to also use our site. To restore access and understand how to better interact with our site to avoid this in the future, please have your system administrator contact [email protected].
Type 1 Thyroplasty – Silastic
Type 1 thyroplasty is used to close glottic gaps due to an immobile or atrophied vocal fold. It is performed via an external approach with local anesthetic and the patient under monitored anesthesia care. Vocalization during implant carving and placement allows for “tuning” of the implant. Type 1 thyroplasty can be combined with arytenoid adduction if needed to close the posterior glottis.
Procedure
Type 1 Thyroplasty – Silastic
Indications
Vocal fold paralysis with glottic incompetence
Contraindications
History of previous external beam radiation is a relative contraindication due to the increased risk of implant extrusion.
Setup
Anesthetic type: local anesthesia and monitored anesthesia care. A flexible nasolaryngoscope is suspended in the patients nose throughout the case to visualize the larynx. The patient is typically positioned supine, with a shoulder roll, in lawnchair position with their arms tucked at their side.
Preoperative Workup
In office laryngoscopy and voice evaluation should be performed pre-operatively. Anti-coagulation and anti-platelet agents should be help peri-operatively. Pre-op antibiotics and airway dose steroids should be given prior to incision.
Anatomy And Landmarks
The incision is made a the mid thyroid cartilage level with flap raised up the thyroid notch and down to the cricoid. When placing the implant, removing the inner perichondrium is key to allowing precise vocal fold medialization.
Advantages/Disadvantages
Vocalization during implant carving and placement allows for “tuning” of the implant. However, type 1 thyroplasty alone is best for the membranous larynx. It can be combined with arytenoid adduction if needed to close the posterior glottis. Some individuals may be unable to tolerate the procedure under local and monitored anesthesia care. An LMA can be placed; however, the surgeon looses the ability to “tune” the implant.
Complications/Risks
Endolaryngeal hematoma can cause stridor and airway obstruction. Meticulous hemostasis is important. Visualization of the larynx with the endoscope can help prevent misplacement of the implant too superior, too inferior, or too anterior. Subsequent intubation can cause dislodgement of the implant. Implant extrusion can also occur, especially in the setting of previous external beam radiation.
Disclosure of Conflicts
Spring and Elsevier royalties
Acknowledgements
N/A
References
Silastic Medialization Laryngoplasty for Unilateral Vocal Fold Paralysis. In Rosen C and Simpson B eds. Operative Techniques in Laryngology. pgs. 241-250. Springer
Laryngology 101 – Medialization Laryngoplasty
Medialization Laryngoplasty is a procedure to augment a vocal cord that is weak, atrophic, bowed or paralyzed. This video show how one laryngeal surgeon, James P Thomas performs the procedure. It is also know as a thyroplasty because the surgery is done through the thryoid cartilage.
Type I thyroplasty
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MEDIALIZATION THYROPLASTY
There are many different reasons for vocal cord paralysis. Some of the common causes are surgical injury to the recurrent laryngeal nerve (the nerve that provides movement for the vocal cord), cancers of the larynx (voice box) or the lungs, viruses, strokes, neck trauma, thyroid cancer, or traumatic placement of an endotracheal tube. Depending on the cause of the vocal cord paralysis, it may be temporary or permanent. In addition, there may only be a partial weakening of the vocal cord. In this instance, it is referred to as vocal cord paresis.
Vocal cord paralysis usually presents as hoarseness, a weak or breathy voice, or some coughing and choking while drinking thin liquids like water. Because the two vocal cords cannot adequately close during swallowing, patients are at risk of aspiration, where swallowed foods and/or liquids enter the trachea. This can lead to pneumonia. Patients with vocal cord paralysis will often complain of “running out of air,” especially during conversation.
It can take up to twelve months to determine if a vocal cord paralysis is permanent. During this time, patients can be quite disabled, and the symptoms can adversely affect their work and quality of life. Patients sometimes derive benefit from voice therapy, but this may be time consuming and not achieve the desired voice. For patients who want to try a conservative approach in the hopes that the paralyzed vocal cord will regain normal function, a vocal cord injection can be done to bulk up the paralyzed vocal cord. The injection lasts for several months up to a year and can be repeated if necessary.
If the vocal cord paralysis is deemed permanent, your surgeon at Suburban Ear, Nose, and Throat can perform a definitive surgical procedure to rehabilitate the voice. This procedure is called a medialization thyroplasty. The surgery is done under twilight anesthesia, and the technique involves making an incision in the skin of the neck and then cutting a small window into the larynx. Then, a permanent implant is placed to medialize (push inward) on the paralyzed vocal cord so that it can touch the other vocal cord during speech and swallowing. This surgery will usually require a one-night stay in the hospital and full recovery takes about one week. Patients usually enjoy a significant improvement in function and quality of life.
Voice-Surgery-Videos
Voice Surgery Videos
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Philadelphia Voice Center
Professional Voice Care, Otolaryngology-Head and Neck Surgery
Surgery: Type I Thyroplasty using Gore-Tex Implant
Voice and vocal folds prior to thyroplasty
Voice result following thyroplasty
Type I Thyroplasty: Gore-Tex Implant
Surgery for Vocal Fold Paresis and/or Paralysis
Thyroplasty is a surgery performed to help the vocal folds close completely during talking and singing. It is ususally performed with one or both vocal folds is weak from a nerve injury or incompletely functioning laryngeal nerve.
The videos show a patients vocal folds before surgery, the surgical procedure, and the vocal folds after surgery.
Microscopic Direct Laryngoscopy with
Microflap Excision of Bilateral Vocal Fold Polyps
Vocal folds and voice with polyps before surgery
Surgery: Microscopic Direct Laryngoscopy with Microflap Excision of Bilateral Vocal Fold Polyps
Vocal folds and voice after surgery to remove polyps
Microscopic Direct Laryngoscopy with
Microflap Excision of Subepithelial Cyst
Right vocal fold cyst and voice before surgery
Surgery: Microscopic Direct Laryngoscopy with Microflap Excision of Subepithelial Cyst
Vocal folds and voice after microflap excision of right vocal fold cyst
Vocal fold polyps and cysts form as a result of phonotrauma, which is excessive force of vocal fold vibration, usually caused by hyperfunctional vocal behaviors.
They do not typically resolve with voice therapy alone, and usually require surgical excision.
Voice therapy is helpful before and after surgery to eliminate the vocal behaviors that caused the original formation of the polyps and cysts.
Subepithelial cysts typically form from obstruction of a gland within the vocal fold.
Unlike polyps, nodules, and cysts on the vibratory margin, they lie underneath the mucosal cover of the vocal fold, instead of involving it directly.
Surgical excision involves removing the cyst from within the substance of the vocal fold without causing trauma to the lining tissue or underlying vocal ligament.
Post-operative voice therapy aids the healing process.
Copyright 2014 Reproduction of content, pictures, or videos without written permission from Philadelphia Voice Center is strictly prohibited by law
Laryngeal Recovery Following Type I Thyroplasty
Abstract
Objective To describe the pattern of laryngeal recovery and its relationship to voice improvement following thyroplasty.
Design We used a 5-point scale to rate 5 laryngeal characteristics preoperatively and 1 day, 1 week, 1 month, and 3 months following thyroplasty.
Setting A university-affiliated health center.
Patients Forty-four patients who underwent thyroplasty to correct incomplete glottal closure.
Results Improved glottal closure and reduced supraglottic activity followed thyroplasty. Although evidence of postoperative irritation (erythema, edema, or hematoma) was present in many patients, it resolved within the first 1 to 4 weeks postoperatively in 22 (73%) of the 30 subjects available for follow-up at 3 months following thyroplasty.
Conclusions Thyroplasty is an effective procedure in correcting incomplete glottal closure and works to reduce excessive supraglottic activity in some patients. Recovery from postoperative vocal-fold irritation occurs rapidly, typically between the first week to first month, depending on the type and severity of irritation. These findings may help explain variations in postoperative voice improvement.
TYPE I thyroplasty has become a primary choice of treatment in cases of unilateral vocal-fold paralysis1 and other conditions leading to incomplete glottal closure.2 This procedure has been shown to be quite successful in restoring voice,1,3-5 with a high degree of patient satisfaction.6
Reports of voice improvement following thyroplasty indicate variation during the time following the procedure. Sasaki et al5 described improved voice function on the first postoperative day, with subsequent improvement at 1 and 3 postoperative months. Tucker7 also reported marked voice improvement up to 3 weeks postoperatively but noted that, in some cases, voice initially deteriorated compared with the intraoperative status before improving again. Netterville et al8 reported initial voice improvement intraoperatively, followed by a rapid deterioration. They attributed this deterioration in voice performance to the development of edema. Vocal quality improved within the first postoperative week, presumably corresponding to remission of edema.
Aside from the observations by Netterville et al8 of postoperative voice deterioration suspected to be associated with edema, few descriptions of laryngeal changes associated with thyroplasty have been discussed. Given the reported variability in postoperative vocal function, knowledge of laryngeal recovery after thyroplasty is warranted. Our purpose is to describe that pattern of laryngeal recovery.
Subjects and methods
Subjects
The subject group consisted of 44 patients who had undergone a unilateral type I thyroplasty to correct glottic insufficiency. Diagnoses contributing to glottic insufficiency are given in the following tabulation:
Five of these patients required revision of the thyroplasty due to extrusion (n=3) or movement (n=2) of the implant. A sixth patient underwent a second thyroplasty in an attempt to provide additional voice improvement subsequent to the initial operation. Hence, 50 procedures performed on 44 patients provided the database for the laryngoscopic measures.
Sixteen of the patients were men; 28, women. They ranged in age from 22 to 84 years. Twenty-six of the patients underwent a left-sided thyroplasty, whereas 17 patients underwent a right-sided thyroplasty. One patient underwent bilateral medialization in an attempt to correct bilateral vocal-fold bowing. All patients underwent a type I thyroplasty as described by Cotter et al.9
Each procedure was performed by the attending physician (N.J.C.), who was assisted by an otolaryngology resident. Intraoperative videolaryngoscopy was performed by the speech pathologist (M.A.C.). Local anesthesia with intravenous sedation was used in all procedures.
A window was outlined on the desired side of the thyroid cartilage at the estimated level of the vocal fold, approximately halfway between the thyroid notch and the lower border of the thyroid cartilage at the midline. The window dimensions were altered individually, and in general were smaller for women and larger for men. The average size of the window was 4×10 mm. A knife was used to incise the cartilage window in most patients. A small diamond burr drill was then used to remove the remaining cartilage, and the inner perichondrium was left intact. A wedge-shaped implant with a lateral extension or key piece was then cut from a silastic block for each patient. The implant was inserted into the pocket under videolaryngoscopic guidance. The implant may have been removed and custom fit several times to achieve the ideal medialization. Occasionally, a separate small wedge of silastic was inserted adjacent to the implant to increase medialization. The incision was then closed with reapproximation of the infrahyoid and platysma muscles. Patients usually received prophylactic antibiotics for several days. They were observed for several hours in the recovery room, and then were discharged to a local hotel with an appointment for videolaryngoscopy the following morning. Some patients required hospital admission for preexisting medical conditions.
Procedure
Laryngoscopic examinations were conducted at the following times relative to surgery: preoperatively, intraoperatively, and at 1 day, 1 week, 1 month, and 3 months postoperatively. All examinations were recorded on a videocassette recorder for subsequent analysis.
Five laryngeal characteristics were evaluated using an ordinal scale. These characteristics included the degree of glottal closure, the amount of supraglottic compression, and evidence of erythema, edema, and hematoma. Five-point ordinal scales were used to rate each of the parameters, as shown in the following tabulation:
All parameters were rated by 2 third-year otolaryngology residents on a consensus basis. Interrater reliability was established by having a third examiner independently rate 20 of the videos. Pearson product moment correlation (r) values ranged from 0.56 to 1.00 for individual parameters, with a correlation of 0.87 for all parameters combined.
Results
Glottal opening
Preoperative ratings showed that 20 of the patients received a rating of 3, whereas 9 others received a rating of 1. Hence, the most common glottal configurations observed preoperatively were large and small glottal gaps with no posterior extension.
As shown in Figure 1, a marked reduction in glottal opening occurred intraoperatively. This improved glottal closure was maintained at the 1-day and 1-week postoperative visits.
At the 1-month postoperative visit, 8 (27%) of the 30 patients available for follow-up demonstrated an increase in glottal opening. Three patients were found to have extrusion or movement of the implant and subsequently underwent a revision thyroplasty. Four others demonstrated a reduction in vocal-fold edema corresponding to the increase in glottal opening. The eighth patient exhibited a slight increase in glottal opening that could not be attributed to implant movement or remission of edema.
Continued improvement in glottal closure was maintained for the other 22 (73%) of 30 patients seen at the 3-month postoperative visit.
Supraglottic compression
Excessive supraglottic compression has been viewed as a compensatory laryngeal mechanism in reaction to reduced glottal closure.10,11 Improved glottal closure following thyroplasty was reasoned to contribute to reduced supraglottic compression. Only those patients exhibiting supraglottic compression before surgery were therefore included for analysis.
Patients undergoing 34 (68%) of the 50 procedures demonstrated supraglottic compression preoperatively. Supraglottic compression decreased initially following medialization but increased at the 1- and 3-month postoperative visits (Figure 2). Possible explanations for the increase include subject attrition, implant extrusion, and/or remission of postoperative edema.
Indicators of vocal-fold irritation or trauma
The remaining 3 parameters—erythema, edema, and hematoma—were included as laryngoscopic evidence of irritation or trauma to the vocal folds secondary to surgery. Only those patients exhibiting evidence of vocal-fold irritation at the 1-day postoperative visit were included for the final analysis.
Erythema
Erythema was noted following 34 (68%) of the 50 procedures at the 1-day postoperative visit. An initial increase was observed 1 day postoperatively, with a subsequent decline occurring 1 week to 3 months postoperatively (Figure 3).
Edema
Edema was noted following 38 (76%) of the 50 procedures at the 1-day postoperative visit. As shown in Figure 4, edema increased intraoperatively and reached its highest level 1 day postoperatively. A marked reduction in edema was noted 1 week postoperatively, with further decline occurring at the 1- and 3-month postoperative visits.
Hematoma
Patients undergoing 14 (28%) of the 50 procedures demonstrated evidence of minor vocal-fold hematoma 1 day following surgery. Hematoma in most of these cases (n=12) was rated as mild or moderate. Only 2 of the 14 instances of hematoma were considered to be severe.
As shown in Figure 5, a marked reduction in the hematoma rating was observed 1 week postoperatively. Complete resolution of all hematomas occurred within 1 to 3 months.
Comment
Our data are consistent with those of previous studies1,2,4-6,8 in demonstrating that type I thyroplasty is an effective treatment to improve glottal closure in patients with glottic insufficiency. Possible explanations for increases in glottal opening after 1 month may include shifting or extrusion of the implant, remission of edema, or even altered laryngeal mechanics.
The pattern of laryngeal recovery described herein may have important implications for voice improvement following thyroplasty and patient counseling. Although improved vocal quality is generally noted immediately following placement of the implant, the patient and voice clinician should be aware that marked deterioration in voice performance may occur in the initial postoperative stages. The development of erythema, edema, and/or hematoma immediately following surgery may result in less-than-optimum vocal quality. Resolution of these tissue changes, however, often occurs within the first postoperative week or month, allowing for improved vocal quality. This healing process may occur rapidly within the first postoperative week or may last up to 1 to 3 months, thus supporting the observation of Tucker et al12(p780) that improved vocal quality noted intraoperatively “would often deteriorate for various periods of time before gradually restabilizing at improved levels.” Netterville et al8 also observed a similar trend relative to voice recovery. Specifically, they noted that “the initial voice improvement acquired on the operating table rapidly changes in the recovery room as perioperative edema develops. Although the voice is usually stronger, it is raspy for several days to weeks after surgery.”8(p442)
Conclusions
Our results demonstrated that laryngeal recovery following thyroplasty generally occurs within the first postoperative month. Potential patients should be alerted to the possibility that optimum vocal quality may not be obtained for at least the first 1 to 3 months, if not longer, following medialization. Indeed, Netterville et al8 suggested that vocal samples obtained before 3 months may not be indicative of long-term voice quality. Lack of improved vocal quality immediately following surgery may indicate a prolonged period of healing, rather than surgical failure, for a particular patient.
Accepted for publication August 20, 1997.
Presented in part at the American Speech-Language-Hearing Association Convention, Anaheim, Calif, November 1993.
Reprints: Michael A. Crary, PhD, Department of Communicative Disorders, Box 100174, University of Florida Health Science Center, Gainesville, FL 32605 (e-mail: [email protected]).
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- Health Care (Issue)
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- Vocal cord paralysis
- dysphonia
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- recurrent laryngeal nerve
- thyroplasty
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Type #1 #thyroplasty #with #arytenoid #adduction
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