A Case of Type 2 Thyroplasty Forced to Remove the Titanium Bridge Due to Mucosal Perforation

Abstract

Type 2 thyroplasty (TP2) has been performed as a surgical treatment for adductor spasmodic dysphonia (AdSD) using a titanium bridge (TB), because of its strength and excellent stability. We report a case that did not show voice deterioration after removal of the TB due to mucosal perforation originating from the lower TB during long-term follow-up after TP2. This is the first report of a complication of TB use during long-term follow-up after TP2. A 23-year-old female patient presented with a speech disorder in 201X and was diagnosed as having AdSD. At first, thyro-arytenoid myectomy (TAM) was performed, followed subsequently by botulinum toxin injection therapy (BT therapy). However, despite these treatments, the patient's voice failed to improve. Finally, TP2 was performed in 201X+1. The postoperative voice was satisfactory, but her voice deteriorated again in 201X+4. Formation of granulation tissue was detected in the subglottic space, as a result of a mucosal break caused by the lower TB. Despite conservative therapy with medications, the granulation tissue developed and disappeared repeatedly. Therefore, operation for removal of the TB was performed under local anesthesia in 201X+5. The intra-operative voice was not spasmodic, and the postoperative voice also remained unchanged. The granulation tissue disappeared. Currently, the postoperative voice profile is 0/21 mora, and G0. After the removal of the TB, the upper TB maintained the expansion of the thyroid cartilage and the voice remained unchanged after its removal. Complications arising from TBs must be borne in mind. After TP2, if granulation tissue appears in the subglottic space, removal of the TB should be considered.