Thyroplasty

Medialization Thyroplaty using Gor-Tex

Vocal fold paralysis
Rather common problem
Causes speech problems (Wasting of voice)
Aspiration – If the opposite cord compensates inadequately

Management modalities
Voice therapy
Cord injection – Teflon, fat, collagen
Medialization thyroplasty using Teflon / Gor-Tex
Re-innervation techniques (early stages)
Gor-Tex was first used as an implant material for medialization by Hoffman and McCullouch in May 1996

Indications for medialization thyroplasty
Unilateral vocal fold immobility due to paralysis / paresis / atrophy
Unilateral vocal fold scarring / soft tissue loss
In select cases of Parkinsonism with vocal fold atrophy
In patients who aspirate due to vocal fold paralysis without the opposite cord compensating adequately

Contraindications
Previous history of irradiation
Malignant lesions involving larynx
Poor abduction of contralateral vocal fold as this could compromise the airway
Patients with poor pulmonary reserve

Advantages of Gor-Tex
Gor-Tex is expanded polytetrafluroethylene
It is malleable
Its position can easily be adjusted via the thyroid cartilage window
Can easily be inserted via a small opening
Reversible

Advantages of Gor-Tex (contd)
The procedure has very little complications
Creates less oedema than silastic hence over correction is not a possibility
Quality of voice is pretty good

Procedure
Performed under local anesthesia
Horizontal skin crease incision starting at the midportion of thyroid cartilage extending to the paralysed side
Strap muscles are separated and held apart by an umbilical tape

Thyroid cartilage cuts
Tracheal hook is used at the level of thryoid prominence to pull the cartilage medially
Thyroid perichondrium is incised in the midline and extended laterally
Cricoid laminae is skeletonized up to the level of cricothyroid membrane on the paralyzed side

Dimensions of cartilage cuts
Size of the cartilage window – 5mmx10mm
Lower border of window should be atleast 3 mm above cricothryoid membrane
Anterior border should be about 8 mm posterior to midline
Fissure burr could be used to create the window

Cartilage cuts

Inner perichondrium
Inner perichondrium is elevated from under the lamina of thyroid cartilage
The inner perichondrium is incised posteriorly and inferiorly
A septal elevator can be introduced via the inferior margin of thyroid lamina and medial pressure can be applied to assess the patient's voice
If result is good then Gor-Tex can be inserted

Insertion of Gor-Tex strips
1 cm wide strips of Gor-Tex dipped in Bacitracin solution is introduced via the window created
Insertion is performed via the inferior margin of thyroid lamina and delivered via the cartilage window
Amount of Gor-Tex insertion depends on the quality of voice

Gor-Tex inserted

Thankyou

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Thyroplasty

by Balasubramanian Thiagarajan

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