Surgical Treatment of Highly Breathy Dysphonia Due to Unilateral Vocal Fold Paralysis : Arytenoid Adduction Combined with Nerve-muscle Pedicle Flap Transfer

Abstract

Improvement of breathy dysphonia due to unilateral vocal fold paralysis (UVFP) is usually achieved by implementing various kinds of phonosurgical procedures, including intracordal injection, type I thyroplasty, arytenoid adduction (AA), and combinations thereof. However, some patients do not recover their “normal” voices after surgery. Normal voices can be attained by providing the immobile vocal fold with the median location and symmetrical bulk and tension of the unaffected vocal fold. Because phonosurgical procedures offer “static” adjustment of these features, the thyroarytenoid muscle (TA) does not work as the body of the immobile vocal fold, resulting in little contribution to voice production and tuning. The authors refined the technique of nerve-muscle pedicle (NMP) flap implantation onto the TA muscle and have applied this innovative method, together with AA, in the treatment of breathy dysphonia due to UVFP since July 2002. Ninety-six patients had undergone NMP flap transfer and AA as of July 2016. The operative procedures are described in detail. Long-term follow-up over 2 years in 47 patients revealed significant improvement in the phonatory function after surgery. Furthermore, most parameters showed significant improvement during the follow-up period.