Medialisation thyroplasty (short: thyroplasty) is indicated in patients with glottic insufficiency. This can be the case after recurrent nerve paralysis, chordectomy after tumor operations of vocal fold(s), presbylarynx, vocal fold bowing, and other disorders.
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.
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.