Laryngeal complications after type I thyroplasty

Abstract

Type I thyroplasty has become a primary surgical choice for voice restoration in patients with glottal incompetence. This study examines factors associated with laryngeal complications after type I thyroplasty. Ten laryngoscopic variables were analyzed from preoperative, intraoperative, and postoperative videolaryngoscopies of 51 patients undergoing 58 medialization procedures. Ten patient and operative variables were examined by medical record review. Major complications were defined as wound hemorrhage, airway obstruction, or prosthesis extrusion. Minor complications were defined as vocal fold hematoma without airway obstruction or prosthesis movement. The major complication rate was 8.6%, and the minor complication rate was 29%. No delayed hemorrhage or airway obstruction occurred. Prosthesis extrusion occurred in five (8.6%) patients 1 week to 5 months after surgery. Extrusion was associated with suboptimal prosthesis placement in 80% of cases. Two patients retained excellent glottal closure despite extrusion. Vocal fold hematoma was identified in 14 (24%) cases and resolved within 1 week. Prosthesis movement occurred in three (5%) patients 1 week to 6 months after surgery and resulted in poor glottal closure. All patients with prosthesis extrusion or movement were female. Type I thyroplasty remains a safe outpatient procedure with few major complications. Prosthesis extrusion was associated with suboptimal prosthesis placement and may or may not result in poor glottal closure. Minor vocal fold hematomas were relatively frequent, resolved rapidly, and were not associated with airway obstruction. Female patients may be more prone to complications because of their small laryngeal size.

Laryngeal framework surgery for the management of aspiration

“…11,15,16 Although these should be taken into consideration, their incidence is low, as evidenced by our 1.4% extrusion rate and a 3% incidence of laryngeal edema. Continuous endoscopic monitoring during the surgery helps reduce misplacement of the prosthesis and under-or overmedialization.…”

Arytenoid adduction as an adjunct to type I thyroplasty for unilateral vocal cord paralysis

“…Extrusion occurred in an additional 7% (4/60); 3 had no change in voice after extrusion. Cotter et al 21 reported a 9% incidence of implant extrusion and attributed this to suboptimal prosthesis placement or violation of the laryngeal perichondrium and mucosa. Minor vocal hematomas were observed in 24% and resolved between 1 week and 1 month without additional intervention.…”

Postthyroplasty Implant Extrusion

“…It was thought that the smaller laryngeal size in females contributed to them being more likely to have this complication of implant extrusion. Two out of these 5 patients who had implant extrusion retained excellent glottic closure [5] . Tucker et al [9] have also reported this phenomenon in another series.…”

“…A study conducted by Cotter et al [5] described the results of 58 cord medialization procedures in 51 patients. The extrusion of implant was reported in only 5 (8.6%) cases, and interestingly, all those cases were females.…”