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□Phonosurgery - various procedures designed to alter the voice 1. vocal fold surgery (LMS, injection) 2. laryngeal framework surgery 3. neurolaryngeal surgery (laryngeal reinnervation procedures) 4. post-laryngectomy voice rehabilitation |
□Thyroplasty (Laryngoplasty, glottoplasty, Laryngeal framework surgery) 1915: Payr 1974: Isshiki et al. , four types type I : Lateral compression (medial displacement) type II :Lateral expansion (lateral displacement) type III:Shortening (relaxation) type IV:Lengthening (stretching, tensioning) Thyroplasty type I: popular use |
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□Indication for thyroplasty Type I: 1. Vocal fold paralysis, unilateral. 2. Vocal fold atrophy (aging,…) 3. Sulcus vocalis 4. Soft tissue defects resulting from excision of pathologic tissue Type II: 1. Adductor spasmodic dysphonia 2. Hyperfunctional dysphonia 3. Dysphonia plica ventricularis Type III: For too high pitch. Mutational voice disorder, Sulcus vocalis Type IV: vs. Arytenoid adduction Lateralized cord lies on a superior plane to the opposite cord (Paralysis of the external branch of the superior laryngeal n.) |
□Pre-op evaluation: 1. detect possible underlying disease 2. F/U at least 6 months (voice training, medication) 3. Laryngeal finding Position of the paralysed vocal fold (horizontal, vertical) Compensate by using the supraglottic structures 4. type of proceeding surgery (scar, granulation - poor prognosis) 5. age (calcification of thyroid cartilage) Prosthesis: 1. autologous cartilage from the superior half of the thyroid ala 2. silastic prosthesis 3. silicon shim, silicon plug 4. hydroxyl appatite modification: 1. minimal surgery: less edema during surgery (cutting thyroid window) 2. overmedialization of the vocal cord (op-edema, denervation atrophy) |
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□Advantages of thyroplasty 1. local anesthesia, minimal or no discomfort 2. neutral head position, better assessment of voice during the procedure 3. potentially reversible 4. structural integrity of the vocal fold is preserved. Preserve the mucosa wave. (prosthesis is placed lateral to the inner perichondrium of the thyroid lamina) |
□Complication of thyroplasty 1. penetration of the endolaryngeal mucosa 2. wound infection 3. chondritis 4. implant migration or extrusion 5. airway obstruction (inpatient observation for >24 hrs) |
| Reference 1. Thyroplasty as a new phonosurgical technique. Isshiki N. et al. Acta Otolaryng 78: 451-7, 1974. 2. Thyroplasty type I for dysphonia due to vocal cord paralysis or atrophy Isshiki N. et al. Acta Otolaryng 80: 465-73, 1975. 3. Recent modifications in thyroplasty type I. Isshiki N. et al. Ann Otol Rhinol Laryngol 98: 777-9, 1989. 4. Surgical alteration of the vocal pitch. Isshiki N. et al. The J. of Otolaryngology 12:5 335-40, 1983. 5. Midline lateralization thyroplasty for adductor spasmodic dysphonia. Isshiki N. et al. Ann Otol Rhinol Laryngol 109:187-93, 2000. 6. Thyroplasty for adductor spasmodic dysphonia: further experiences. Isshiki N. et al. Laryngoscope. 111: 615-21, 2001. 7. Laryngeal framework surgery (thyroplasty) Harries M. The J. of laryngology and Otology 111, 103-5, 1997. 8. Longitudinal voice quality changes following Isshiki thyroplasty type I: the Yale experience. Sasaki C. T. et al. Laryngoscope. 100: 849-52, 1990. 9. Evaluation of vocal function in unilateral vocal fold paralysis following thyroplastic surgery. Adams S. G. et al. The J. of Otolaryngology 25:3 165-70, 1996. 10. Phonosurgical procedures. Flint P.W., Cummings C. W. Chapter 110 p 2073-95 Otolaryngology head and neck surgery 3rd edition. Mosby. |