International Journal of Head and Neck Surgery

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VOLUME 12 , ISSUE 4 ( October-December, 2021 ) > List of Articles

Invited Review Articles

Type I Thyroplasty and Arytenoid Adduction: Review of the Literature and Current Clinical Practice

Sarah K Rapoport, Mark S Courey

Keywords : Arytenoid adduction, Dysphonia, Implant carving, Isshiki type I, Medialization laryngoplasty, Medialization thyroplasty, Vocal fold atrophy, Vocal fold paralysis

Citation Information : Rapoport SK, Courey MS. Type I Thyroplasty and Arytenoid Adduction: Review of the Literature and Current Clinical Practice. Int J Head Neck Surg 2021; 12 (4):166-171.

DOI: 10.5005/jp-journals-10001-1517

License: CC BY-NC 4.0

Published Online: 21-05-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Aim: Dysphonia resulting from glottic insufficiency or vocal fold immobility can be a distressing and debilitating condition. The ability to medialize a vocal fold and reposition an immobile arytenoid to allow patients to regain quality, stamina, and reliability of their voice can be achieved through type I medialization thyroplasty with concurrent arytenoid adduction when indicated. Background: Medialization thyroplasty and arytenoid adduction techniques have been honed and reliably performed for decades. The durability of these procedures has been well demonstrated. Additionally, they are routinely performed under local anesthesia with moderate anesthetic sedation enabling frail patients, suffering from glottic insufficiency who are otherwise poor surgical candidates, the opportunity to pursue laryngeal framework surgery and regain vocal strength while risking low overall morbidity. Review results: Understanding how to apply the nuances of these surgeries can yield reliable and successful outcomes. Appreciating these subtle details in the context of the historical development of these procedures is beneficial for any otolaryngologist performing these procedures. Conclusion: Type I thyroplasty and arytenoid adduction procedures have been meticulously refined over time. As a result they are technically elegant and simple procedures that rely on intraoperative precision to optimize postoperative voice outcomes. Disclosures: Please note, this manuscript has not been submitted or presented elsewhere prior to submission here. All authors have no conflicts of interest, sources of external funding related to this publication, or financial disclosures related to this publication to declare.


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  1. Isshiki N, Morita H, Okamura H, et al. Thyroplasty as a new phonosurgical technique. Acta Oto-laryngologica 1974;78(1–6): 451–457. DOI: 10.3109/00016487409126379
  2. Koufman JA, Otolaryngol Clin North Am Isaacson G. Laryngoplastic phonosurgery. 1991;24(5):1151–1177. DOI: 10.1016/S0030-6665(20)31073-2
  3. Isshiki N, Okamura H, Ishikawa T. Thyroplasty type I (lateral compression) for dysphonia due to vocal cord paralysis or atrophy. Acta Otolaryngol 1975;80(1–6):465–473. DOI: 10.3109/00016487509121353
  4. Isshiki N, Tanabe M, Sawada M. Arytenoid adduction for unilateral vocal cord paralysis. Arch Otolaryngol 1978;104(10):555–558. DOI: 10.1001/archotol.1978.00790100009002
  5. Woo P. Arytenoid adduction and medialization laryngoplasty. Otolaryngol Clin North Am 2000;33(4):817–840. DOI: 10.1016/s0030-6665(05)70246-2
  6. Billante CR, Clary J, Sullivan C, et al. Voice outcome following thyroplasty in patients with longstanding vocal fold immobility. Auris Nasus Larynx 2002;29(4):341–345. DOI: 10.1016/s0385-8146(02)00020-2
  7. Netterville JL, Stone RE, Civantos FJ, et al. Silastic medialization and arytenoid adduction: The vanderbilt experience. Ann Otol Rhinol Laryngol 1993;102(6):413–424. DOI: 10.1177/000348949310200602
  8. Chang J, Schneider SL, Curtis J, et al. Outcomes of medialization laryngoplasty with and without arytenoid adduction. Laryngoscope 2017;127(11):2591–2595. DOI: 10.1002/lary.26773
  9. Zeitels SM, Hochman I, Hillman RE. Adduction arytenopexy: A new procedure for paralytic dysphonia with implications for implant medialization. Ann Otol Rhinol Laryngol Suppl 1998;173:2–24.
  10. Zeitels SM, Mauri M, Dailey SH. Adduction arytenopexy for vocal fold paralysis: indications and technique. J Laryngol Otol 2004;118(7): 508–516. DOI: 10.1258/0022215041615263
  11. Rosen CA. Complications of phonosurgery: Results of a national survey. Laryngoscope 1998;108(11 Pt 1):1697–1703. DOI: 10.1097/00005537-199811000-00020
  12. Weinman EC, Maragos NE. Airway compromise in thyroplasty surgery. Laryngoscope 2000;110(7):1082–1085. DOI: 10.1097/00005537-200007000-00003
  13. Tucker HM, Wanamaker J, Trott M, et al. Complications of laryngeal framework surgery (phonosurgery). Laryngoscope 1993;103(5): 525–528. DOI: 10.1288/00005537-199305000-00008
  14. Woo P, Pearl AW, Hsiung MW, et al. Failed medialization laryngoplasty: management by revision surgery. Otolaryngol Head Neck Surg 2001;124(6):615–621. DOI: 10.1067/mhn.2001.116021
  15. Cotter CS, Avidano MA, Crary MA, et al. Laryngeal complications after type 1 thyroplasty. Otolaryngol Head Neck Surg 1995;113(6):671–673. DOI: 10.1016/s0194-5998(95)70003-x
  16. Hoffman HT, McCulloch TM. Anatomic considerations in the surgical treatment of unilateral laryngeal paralysis. Head Neck 1996;18(2): 174–187. DOI: 10.1002/(SICI)1097-0347(199603/04)18:2<174::AID-HED10>3.0.CO;2-F
  17. McCulloch TM, Hoffman HT. Medialization laryngoplasty with expanded polytetrafluoroethylene. Surgical technique and preliminary results. Ann Otol Rhinol Laryngol 1998;107(5 Pt 1): 427–432. DOI: 10.1177/000348949810700512
  18. Giovanni A, Vallicioni JM, Gras R, et al. Clinical experience with gore–tex for vocal fold medialization. Laryngoscope 1999;109 (2 Pt 1):284–288. DOI: 10.1097/00005537-199902000-00020
  19. Montgomery WW. XXIX cricoarytenoid arthrodesis. Ann Otol Rhinol Laryngol 1966;75(2):380–391. DOI: 10.1177/000348946607500207
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