Autologous thyroid cartilage graft implantation in medialization laryngoplasty: a modified approach for treating unilateral vocal fold paralysis

Ming-Shao Tsai,Meng-Hung Lin,Ming-Yu Yang,Geng-He Chang,Cheng-Ming Hsu,Yao-Te Tsai

doi:10.1038/s41598-017-05024-6

Ming-Shao Tsai, Meng-Hung Lin + Show 4 more

Open Access

https://doi.org/10.1038/s41598-017-05024-6

Copy DOI

Abstract

Medialization laryngoplasty is the standard surgical treatment for unilateral vocal fold paralysis. This study presents a modified approach in which a thyroid cartilage graft is implanted in medialization laryngoplasty. 22 patients who underwent this approach were included in the study. The results revealed that glottal incompetence and vocal performance were markedly improved following surgery, and the follow-up period ranged from 6 to 74 months (mean, 21.4 months). Acoustic analysis revealed significant improvements in the maximum phonation time (from 3.51 to 7.89 seconds, p < 0.001), F0 (from 221.7 to 171.0 Hertz, p = 0.025), and jitter (from 7.68 to 3.19, p < 0.001). Perceptual assessment revealed a significant decrease in voice grading (from 2.59 to 1.41, p < 0.001), roughness (from 1.82 to 1.23, p = 0.004), and voice breathiness (from 2.55 to 1.23, p < 0.001). None of the patients exhibited severe wound infection, tissue rejection, or other complications attributed to the surgical procedure. In conclusion, autologous thyroid cartilage implantation in medialization laryngoplasty medializes the vocal cord, minimizes the glottal gap, and improves the voice of patients with vocal fold paralysis. This procedure is characterized by simplicity, safety, and acceptable results.

Highlights

Unilateral vocal fold paralysis (UVFP) occurs when one vocal fold is paralyzed in the paramedian or lateral position with very limited movement[1]
We reviewed the medical records of 25 consecutive patients with UVFP who were managed with the Isshiki type I thyroplasty technique using autologous thyroid cartilage implants with or without arytenoid adduction (AA) from January 2012 to March 2016
Payr made a U-shaped incision with a pedicled cartilage flap, and Smith used the upper portion of a contralateral alar cartilage graft

Summary

Introduction

Unilateral vocal fold paralysis (UVFP) occurs when one vocal fold is paralyzed in the paramedian or lateral position with very limited movement[1]. Isshiki type I thyroplasty with nonresorbable biomaterials, such as silicone, Gore-Tex, hydroxyapatite, titanium, and expanded polytetrafluoroethylene, has been performed in the past few decades[29,30,31,32,33,34] These materials are effective for vocal improvement, they are associated with disadvantages such as graft rejection and some potential complications. In 1915, Payr used an anteriorly pedicled thyroid cartilage flap to medialize the vocal fold[41] This method did not gain popularity because of some disadvantages regarding technique and its limited effect[41]. This study investigated functional outcomes after medialization thyroplasty using autologous thyroid cartilage implants for treating UVFP

Methods

Results

Conclusion