62 - Medialization Thyroplasty

Abstract

Both medialization thyroplasty and vocal fold injection can be used successfully to manage glottal insufficiency associated with unilateral vocal fold motion impairment, vocal fold bowing, and soft tissue deficits. The choice of procedure, medialization thyroplasty or vocal fold injection, and injectable material should account for anatomic considerations, severity and duration of symptoms, potential for recovery, and patient health and life expectancy. Videostroboscopy is useful for both preoperative and postoperative evaluation of patients with vocal fold motion impairment. Electromyography is the only test available to evaluate the integrity of the laryngeal motor unit. Vocal fold injections can be performed percutaneously or transorally with local anesthesia or via direct laryngoscopy with general anesthesia. Injections for vocal fold medialization should target the paraglottal space lateral to the vocalis muscle, whereas intracordal injections for soft tissue deficits are more superficial but deep to the lamina propria, avoiding Reinke's space.