Medialization Thyroplasty Using Autologous Nasal Septal Cartilage for Treating Unilateral Vocal Fold Paralysis

Abstract

ObjectivesA persistent insufficiency of glottal closure is mostly a consequence of impaired unilateral vocal fold movement. Functional surgical treatment is required because of the consequential voice, breathing and swallowing impairments. The goal of the study was to determine the functional voice outcomes after medialization thyroplasty with using autologous septal cartilage from the nose.MethodsExternal vocal fold medialization using autologous nasal septal cartilage was performed on 15 patients (6 females and 9 males; age range, 30 to 57 years). Detailed functional examinations were performed for all the patients before and after the surgery and this included perceptual voice assessment, laryngostroboscopic examination and acoustic voice analysis.ResultsAll the patients reported improvement of voice quality post-operatively. Laryngostroboscopy revealed almost complete glottal closure after surgery in the majority of patients. Acoustic and perceptual voice assessment showed significant improvement post-operatively.ConclusionMedialization thyroplasty using an autologous nasal septal cartilage implant offers good tissue tolerability and significant improvement of the subjective and objective functional voice outcomes.

Autologous thyroid cartilage graft implantation in medialization laryngoplasty: a modified approach for treating unilateral vocal fold paralysis

“…Subsequently, in an animal study, vocal fold paralysis was treated with elastic auricular cartilage injection 38 . Recently, human autologous cartilage, such as nasal or auricular cartilage, has been used as potentially permanent implant materials for injection laryngoplasty 39 , 40 . The successful outcomes of autologous cartilage graft implantation suggest that these grafts can be used in medialization laryngoplasty.…”

Glottal insufficiency with thyroid cartilage implantation: Our experience in eight patients

“…There are some advantages of autologous grafts including the relatively high biocompatibility and low risk of infection, when they are compared with homografts and alloplastic implants. Although the autologous nasal septal cartilage graft is considered as a safe and effective graft for augmentation, it may be too fragile and requires the need to create another surgical wound and also involves postoperative pain 9 . In contrast, the thyroid cartilage graft is readily available without creating another surgical wound.…”

Treatment of aging vocal folds

“…Framework surgery also includes arytenoid adduction although this is not typically used in nonparalytic glottal incompetence. Recently, Mesallam et al [31] reported use of nasal septal cartilage for type I thyroplasty in 15 patients with unilateral vocal fold paralysis. Commonly used implants include silastic, hydroxyapatite, Gore-tex (expanded polytetrafluoroethylene) and titanium.…”

“…Framework surgery has been recommended for those patients desiring permanent voice change, for those with larger glottal gaps (>3 mm) and for older age groups [29]. Significant improvement in MPT was achieved up to 6 months with no major complications recorded [31]. Local pedicled rotation flaps and other implants have been trialled [30].…”