Thyroplasty

Thyroplasty – What is it?

Permanent vocal fold medialization can also be achieved by surgery on the neck from the outside. For this purpose, an opening („window“) is made in the thyroid cartilage at the level of the paralyzed vocal fold, into which an implant is inserted, thereby pushing the vocal fold toward the center. The operation can be performed under anesthesia or local anesthesia. Various implants are available, including titanium braces, prefabricated silicone wedges, custom-configured silicone wedges, and GoreTex strips. Some surgeons choose autologous cartilage. Usually, this procedure is performed during an inpatient stay. Since this surgery interferes with the cartilage framework of the larynx, it belongs to the so-called „Laryngeal Framework Surgery“. After hundreds of thyroplasties, we have had the best experience with our individually intraoperatively fabricated silicone implants.

Thyroplasty – In which cases it is applied

Medialization thyroplasty (thyroplasty for short) is indicated in cases of inadequate closure of the glottis. This is usually the case with unilateral vocal cord paralysis, but also with voice-enhancing surgery after tumor treatment. This can be the case after recurrent nerve paralysis, chordectomy after tumor operations of vocal fold(s), presbylarynx, vocal fold bowing, and other disorders.
This voice enhancement surgery involves a permanent shift of the vocal fold to the middle by inserting an implant from the outside. This procedure often requires an inpatient stay.

We mostly use a special technique with preoperative 3D-scanning of the larynx with a cone beam imaging technique, the digital volume tomography (DVT). We can then apply a computer aided design (CAD) of the ideal implant size and form.

Thyroplasty

Which implant will be inserted?

We prefer to use our proprietary 3-D reconstruction of thyroplasty implants with preoperative PC-based digital volume tomography (DVT). This allows us to determine the ideal and precisely fitting three-dimensional implant shape before surgery.

Thyroplastik

In cases where augmentations cannot help appropriately, thyroplasties are the preferred choice. A small bean-sized silicone part is implanted via a percutaneous, open-neck procedure. Mostly performed in cases of unilateral vocal fold paralysis and paresis, medialisation thyroplasty (also called Isshiki type I thyroplasty) is an indispensable technique to correct a vocal fold in its mid position and thus enabling complete vocal fold closure – glottic closure – and leading to a much louder voice. Optimal results make the voice near-normal with hardly any audible hoarseness.

We routinely use digital volume tomography (DVT) in order to preoperatively individually calculate the ideal 3-D implant size. Silicone blocks are carved intraoperatively and placed at the previously determined site lateral to the vocal fold resulting in very favorable voice postoperatively. After having performed hundreds of thyroplasties, we are convinced that this method has its important role in the armamentarium of phonosurgery. Together with arytenoid adduction (AA) operations, for instance when applying our string arytenoid adduction (SAA) technique, the combination of both techniques can lead to even superior results (cf. publications on our website).

The indication will be made from the phonosurgeon together with the patient during the office laryngeal examination when reviewing all results together with the comprehensive voice assessment. Thyroplasties can be performed as an ambulatory procedure or as an in-house, non-ambulatory procedure.

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