Functional Results After External Vocal Fold Medialization Thyroplasty With the Titanium Vocal Fold Medialization Implant

• Published in: The Laryngoscope 2003-04, Vol.113 (4), p.628-634
• Main Authors: Schneider, Berit, Denk, Doris-Maria, Bigenzahn, Wolfgang
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biocompatible Materials; Biological and medical sciences; Deglutition Disorders - etiology; Female; Glottis - physiopathology; Glottis - surgery; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; laryngeal framework surgery; laryngeal obstruction; Laryngoscopy - methods; Male; Medical sciences; Middle Aged; Non tumoral diseases; Otorhinolaryngologic Surgical Procedures - methods; Otorhinolaryngology. Stomatology; Postoperative Care; Preoperative Care; Prosthesis Implantation - methods; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the upper aerodigestive tract; swallowing; Thyroid Gland - surgery; Titanium - therapeutic use; titanium implant; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Vocal Cord Paralysis - complications; Vocal Cord Paralysis - physiopathology; Vocal Cords - physiopathology; Vocal Cords - surgery; vocal fold medialization; Vocal fold paralysis; voice
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/00005537-200304000-00008

Objectives/Hypothesis A persistent insufficiency of glottal closure is mostly a consequence of a unilateral vocal fold movement impairment. It can also be caused by vocal fold atrophy or scarring processes with regular bilateral respiratory vocal fold function. Because of consequential voice, breathing, and swallowing impairments, a functional surgical treatment is required. The goal of the study was to outline the functional results after medialization thyroplasty with the titanium vocal fold medialization implant according to Friedrich. Methods In the period of 1999 to 2001, an external vocal fold medialization using the titanium implant was performed on 28 patients (12 women and 16 men). The patients were in the age range of 19 to 84 years. Twenty‐two patients had a paralysis of the left‐side vocal fold, and six patients, of the right‐side vocal fold. Detailed functional examinations were executed on all patients before and after the surgery: perceptive voice sound analysis according to the “roughness, breathiness, and hoarseness” method, judgment of the s/z ratio and voice dysfunction index, voice range profile measurements, videostroboscopy, and pulmonary function tests. In case of dysphagia/aspiration, videofluoroscopy of swallowing was also performed. The respective data were statistically analyzed (paired t test, Wilcoxon‐test). Results All patients reported on improvement of voice, swallowing, and breathing functions postoperatively. Videostroboscopy revealed an almost complete glottal closure after surgery in all of the patients. All voice‐related parameters showed a significant improvement. An increase of the laryngeal resistance by the medialization procedure could be excluded by analysis of the pulmonary function test. Conclusions The results confirm the external medialization of the vocal folds as an adequate method in the therapy of voice, swallowing, and breathing impairment attributable to an insufficient glottal closure. The titanium implant offers, apart from good tissue tolerability, the advantage of an easy, time‐saving, and individually adjustable application during the operation.