Revised thyroplasty: The importance of inner perichondrium dissection

Abstract

Purpose: The outcome of voice surgery on unilateral vocal cord paralysis (UVCP) by medialization laryngoplasty (ML) was various although the series of reports consistently claimed that the phonation ability restored well after their reconstructive surgery. We revised several unsatisfactory subjects and proposed a correct concept to facilitate a successful surgery. Patients and Methods: One hundred and forty subjects suffering from UVCP and undergoing ML procedure were reviewed. Eight of the 140 subjects underwent revised thyroplasty to improve their unsatisfactory voice. The time elapse from UVCP onset to first ML procedure and between first and second ML procedure was recorded and analyzed. Maximal phonation time (MPT) was used to evaluate the improvement of phonation ability. Result: Inappropriate size or location of the implant material were defined in two subjects, inappropriate management of the inner perichondrium of thyroid lamina (IPTL) were defined in 5, and cricoarytenoid joint (CAJ) fixation in one. MPT was increased from 3 s to 11 s in average after revised surgery. MPT more than 10 s was obtained in 7 subjects in their followup at mean 15 months. Conclusion: The management of IPTL actually determined the voice surgical outcome significantly. Preoperative evaluation of the CAJ mobility was still an important factor to determine the use of corrective methods.

Keywords

• Medialization laryngoplasty
• thyroplasty
• unilateral vocal cord paralysis
• cricoarytenoid joint
• maximal phonation time