What Is Thyroplasty?

Thyroplasty is a surgical procedure used to correct vocal cord dysfunction‍ and the associated voice disorder known as dysphonia. This complex operation can significantly improve an affected individual’s ability to speak and in certain cases may even restore lost ⁤speaking abilities. It involves repositioning and‌ reconstructing the⁢ larynx (voice box) to improve the mobility of the vocal ‍cord muscles.

Overview of Thyroplasty

Thyroplasty is a ⁢relatively safe and reliable operation that ‍can provide significant ⁣clinical benefits for those suffering from dysphonia. The primary purpose of this procedure is to improve vocal folds mobility,‍ thus allowing for increased range and better sound ‌quality ‌when speaking.



Typically, a thyroplasty is performed on an outpatient basis under general anesthesia. The ⁣procedure usually takes about 90 ​minutes to complete. ‌The process begins with a small incision at the base of the neck and extends to the ​level of the vocal cords. Through ‌this‌ incision,⁤ a special instrument known as a laryngeal retractor is‌ used to retract the muscle and access the vocal cords.



The surgeon will then make one or more tiny incisions on ‍either side of the larynx in order to gain access ​to the vocal folds. The folds are ⁢divided and resected as needed in order to provide greater mobility to the vocal cords. During the procedure, some nerves may be moved to improve precision.

Benefits of Thyroplasty

The primary benefit of thyroplasty is improved vocal quality ‌and ⁢increased vocal range. Patients can expect to⁤ experience better sound quality, fewer strain injuries, and better pitch control. In some cases, the procedure may also help ​to restore lost speaking abilities.



Additional‌ benefits may include increased confidence, greater clarity in speech, improved articulation, and overall improved⁢ speaking ability. Other reported benefits include ⁣improved swallowing, ⁤even for those with swallowing difficulties due to dysphonia.

Expected Results From Thyroplasty

The expected results from thyroplasty vary significantly based on the individual. Generally speaking, most patients can expect to experience improved vocal range, better clarity in speech, and improved articulation. It may also be possible to restore lost speaking abilities, though this is not guaranteed.



It is important to note that the full results of the surgery may not be noticeable until well after the⁢ procedure. Most patients take approximately two to three months to fully heal from the operation. However, it is important to note that the exact time frame for healing may vary based on individual factors, ⁤such as age, overall health, and level of fitness.

Complications ‍and Risks

As with all surgeries, ‍thyroplasty carries certain ⁤risks and complications.⁤ There is ⁤a potential for post-operative infection, prolonged pain, and damage to the nerves that control the vocal cord muscles. There is also the possibility of permanent damage to the vocal cords,​ though this is rare. Bleeding and hematoma formation may also occur in rare cases. As with any surgical procedure, ​it is important to​ discuss⁢ the⁤ potential risks with your⁣ doctor before undergoing a thyroplasty.

Conclusion

Thyroplasty is a surgical procedure used to improve vocal cord mobility ⁤and treat the voice disorder‌ known as‌ dysphonia. This procedure ‍can help improve vocal range, articulation, and clarity in speech as well as potentially restore lost speaking abilities.



Overall, thyroplasty is safe and effective, though it does⁤ carry certain risks and complications such as infection, nerve damage, and hematoma formation. It is important to discuss these risks with a doctor before undergoing a thyroplasty. After the⁤ procedure, it ⁤is ‍also important to ‌follow all post-operative instructions to ensure a safe and successful recovery.

Definition and Overview

Thyroplasty is a specialised procedure performed on the larynx for patients with vocal cord paralysis, a serious condition that occurs when there is an injury to the recurrent laryngeal nerve, which supplies the majority of the muscles of the larynx. Nerve injury can be due to a number of causes, the most common of which is surgery, typically of the thyroid gland. It can also be caused by tumors, radiation injury, and neck trauma, among others.

Who Should Undergo and Expected Results

The vocal cords can be found at the entrance of the trachea. In a normal person, the vocal cords are in an open position at rest to allow breathing. When speaking or making a sound, the vocal cords close off and vibrate. In cases of vocal cord paralysis, there is weakness or immobility of at least one vocal cord, resulting in hoarseness. The condition can also present with aspiration or choking, especially during intake of liquids. Other symptoms include ineffective coughing and even breathing problems. Treatment of vocal cord paralysis depends on the cause. Speech therapy, which includes special exercises, is the primary treatment. Vocal fold injections using fillers, such as fat or collagen, can be performed to add some bulk to the vocal cord. However, in cases wherein the vocal cord is completely paralysed, augmentation may be inadequate. For such cases, thyroplasty is considered.

How is the Procedure Performed?

Thyroplasty, also known as laryngeal framework surgery or medialisation laryngoplasty, is a surgical procedure performed for vocal cord paralysis. Instead of using an injectable filler to augment the vocal cords, thyroplasty makes use of an implant, which can be composed of one or several materials, such as silicone, polytetrafluoroethylene (Goretex), titanium, or the patient’s own cartilage.

A thyroplasty is a short procedure and commonly performed under a combination of local anesthesia and intravenous sedation, allowing the surgeon to check the patient’s voice during the procedure.

A small incision is made in the neck near the area of the larynx and part of the thyroid cartilage is removed to provide access to the vocal cords. The implant is positioned near the vocal cord, pushing the vocal cord as close to the middle section as possible. An implant is usually required on the side of the injury alone. However, in about a third of patients, an implant may also be needed on the opposite side to strengthen it.

In cases wherein an implant cannot fully correct the condition, an additional technique, called arytenoid adduction, can also be performed during the procedure. A suture may be placed through the arytenoid cartilage, allowing the vocal cord to move towards the center and restore the optimal tension on the affected vocal cord. Many surgeons believe that a combination of these two techniques yields the best results in terms of restoring voice quality.

Once the implant has been positioned properly, a fiber optic scope is inserted, allowing the surgeon to view the larynx and check the placement of the implant. The patient may be requested to speak during the laryngoscopy, allowing the surgeon to check the movement of the cords. The results of a thyroplasty are permanent but are reversible by the removal of the implant. In some cases, a second surgery may be necessary if the implants need to be repositioned. Patients are usually sent home a day after the procedure and are advised to avoid strenuous activities for about a week. Resting the voice is also advised and shouting and whispering should be avoided.

Possible Risks and Complications

Thyroplasty is generally a safe procedure, but complications can still occur. These include:

• Poor voice quality – This is a common complication that can be caused by the improper placement of the implant or using the wrong size of the implant.
• Perioperative edema – In some cases, the occurrence of perioperative edema produces good voice quality immediately after the surgery, which changes once the swelling subsides. Some surgeons give steroids preoperatively to minimize edema. In cases where poor voice quality occurs, a revision thyroplasty may have to be performed.
• Implant migration. This is not a common complication, but there have been reports of migration into the airway or through the neck.
• Airway difficulties – Because the surgery involves the larynx, airway difficulties can be a major concern. Swelling, edema and hematoma can cause partial obstruction, which is a serious condition. Use of steroids in both the preoperative and postoperative periods may help prevent this complication.
• Bleeding

• Infection
  
  References:

• Carpes LF, Kozak FK, Leblanc JG, et al. Assessment of vocal fold mobility before and after cardiothoracic surgery in children. Arch Otolaryngol Head Neck Surg. 2011 Jun. 137(6):571-5.

• Yung KC, Likhterov I, Courey MS. Effect of temporary vocal fold injection medialization on the rate of permanent medialization laryngoplasty in unilateral vocal fold paralysis patients. Laryngoscope. 2011 Jul 6.

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