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One hundred years of external approach medialisation thyroplasty

  • V E Crolley (a1) and N Gibbins (a1)

It has been 100 years since Erwin Payr first developed an operation to improve the effects of a paralysed vocal fold, and operations based on this technique are still in use today. This technique, medialisation thyroplasty, aims to improve the symptoms caused by vocal fold palsy by realigning the lateralised vocal fold into the midline.

Whilst the effects of vocal fold palsy were recognised in antiquity, it was only with the development of indirect laryngoscopy in the late nineteenth century that the vocal fold paralysis could be identified as an aetiology for poor phonation and dysphagia. Payr, in 1915, was the first to perform a recognisable form of medialisation thyroplasty, which was further developed in the early twentieth century, but medialisation thyroplasty did not begin to be widely used until the development of the modern technique by Isshiki et al., in 1974.

Since then, medialisation thyroplasty has continued to be developed and is currently the most widely used technique for correcting the effects of vocal fold palsy. However, a wide array of therapeutic options is now available for vocal fold palsy and it is impossible to say whether or not medialisation thyroplasty will still be used in another 100 years.

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2 WW Montgomery , SK Montgomery , MA. Warren Thyroplasty simplified. Oper Tech Otolaryngol Head Neck Surg 1993;4:223–31

3 ML. Harries Laryngeal framework surgery (thyroplasty). J Laryngol Otol 1997;111:103–5

4 MT Abraham , M Gonen , DH. Kraus Complications of type I thyroplasty and arytenoid adduction. Laryngoscope 2001;111:1322–9

5 MT Abraham , MS Bains , RJ Downey , RJ Korst , DH. Kraus Type I thyroplasty for acute unilateral vocal fold paralysis following intrathoracic surgery. Ann Otol Rhinol Laryngol 2002;111:667–71

6 PW Flint , LL Purcell , CW. Cummings Pathophysiology and indications for medialization thyroplasty in patients with dysphagia and aspiration. Otolaryngol Head Neck Surg 1997;116:349–54

7 A Sipp , J Kerschner , N Braune , C. Hartnick Vocal fold medialization in children. Arch Otolaryngol Head Neck Surg 2007;133:767–71

9 PK Lam , WK Ho , ML Ng , WI. Wei Medialization thyroplasty for cancer-related unilateral vocal fold paralysis. Otolaryngol Head Neck Surg 2007;136:440–4

10 E Yumoto , R Minoda , M Hyodo , T. Yamagata Causes of recurrent laryngeal nerve paralysis. Auris Nasus Larynx 2002;29:41–5

11 BH Lang , KK Chu , RK Tsang , KP Wong , BY. Wong Evaluating the incidence, clinical significance and predictors for vocal cord palsy and incidental laryngopharyngeal conditions before elective thyroidectomy: is there a case for routine laryngoscopic examination? World J Surg 2013;38:385–91

12 EJ. Damrose Percutaneous injection laryngoplasty in the management of acute vocal fold paralysis. Laryngoscope 2010;120:1582–90

13 D Assimakopoulos , G Patrikakos , J. Lascaratos Highlights in the evolution of diagnosis and treatment of laryngeal cancer. Laryngoscope 2003;113:557–62

15 PW. Alberti Panel discussion: the historical development of laryngectomy. II. The evolution of laryngology and laryngectomy in the mid-19th century. Laryngoscope 1975;85:288–98

16 A Jahn , A. Blitzer A short history of laryngoscopy. Logoped Phoniatr Vocol 1996;21:181–5

20 LL D'Antonio , TT Wigley , GJ. Zimmerman Quantitative measures of laryngeal function following Teflon injection of thyroplasty type I. Laryngoscope 1995;105:256–62

21 N. Isshiki Phonosurgery: Theory and Practice. Heidelberg: Springer, 1989;7780

22 N Isshiki , H Morita , H Okamura , M. Hiramoto Thyroplasty as a new phonosurgical technique. Acta Otolaryngol 1974;78:451–7

23 JA. Koufman Laryngoplasty for vocal cord medialization: an alternative to Teflon. Laryngoscope 1986;96:726–31

24 JL Netterville , RE Stone , ES Lukas , FJ Civantos , RH. Ossoff Silastic medialization and arytenoid adduction: the Vanderbilt experience. A review of 116 phonosurgical procedures. Ann Otol Rhinol Laryngol 1993;102:413–24

25 JL Netterville , JR Coleman , S Chang , CL Rainey , L Reinisch , RH. Ossoff Lateral laryngotomy for the removal of Teflon granuloma. Ann Otol Rhinol Laryngol 1998;107:735–44

26 RL Crumley , K Izdebski , B. McMicken Nerve transfer versus Teflon injection for vocal cord paralysis: a comparison. Laryngoscope 1988;98:1200–4

29 D Bray , JP Young , ML. Harries Complications after type one thyroplasty: is day-case surgery feasible? J Laryngol Otol 2008;122:715–18

30 HM. Tucker New voices for old. J Voice 1995;9:111–17

31 RL Carrau , A Pou , DE Eibling , T Murry , BJ. Ferguson Laryngeal framework surgery for the management of aspiration. Head Neck 1999;21:139–45

34 GE. Woodson The history of laryngology in the United States. Laryngoscope 1996;106:677–9

35 Y. Meurman Operative mediofixation of the vocal cord in complete unilateral paralysis. Arch Otolaryngol 1952;55:544–53

36 O. Opheim Unilateral paralysis of the vocal cord. Operative treatment. Acta Otolaryngol 1955;45:226–30

37 M Sawashima , G Totsuka , T Kobayashi , H. Hirose Surgery for hoarseness due to unilateral vocal cord paralysis. Arch Otolaryngol 1968;87:8792

38 FM Kamer , ML. Som Correction of the traumatically abducted vocal cord. Arch Otolaryngol 1972;95:69

40 HM. Tucker Complications after surgical management of the paralyzed larynx. Laryngoscope 1983;93:295–8

41 A. Kressner Contribution to the question of vocal cord paralysis and photos of the functional anatomy of the larynx [in German]. Arch Ohr Nas Kehlk-heilk 1953;162:479–96

46 WW. Montgomery Cricoarytenoid arthrodesis. Ann Otol Rhinol Laryngol 1966;75:380–91

47 L Bernstein , GP. Holt Correction of vocal cord abduction in unilateral recurrent laryngeal nerve paralysis by transposition of the sternohyoid muscle. Laryngoscope 1967;77:876–85

48 K. Mündnich A simple and dependable method for stress and displacement of the vocal cords towards the midline in dys- and aphonia with problematic dyspnoea [in German]. Arch Kin Exp Ohr Nas u Kehlk-heilk 1970;196:324–6

50 N. Isshiki Vocal mechanics as the basis for phonosurgery. Laryngoscope 1998;108:1761–6

53 NE. Maragos Type I thyroplasty: pitfalls of modifying the Isshiki approach. How I do it. J Voice 1997;11:470–3

54 NJ Bryant , LC Gracco , CT Sasaki , E. Vining MRI evaluation of vocal fold paralysis before and after type I thyroplasty. Laryngoscope 1996;106:1386–92

55 HS Choi , SM Chung , JY Lim , HS. Kim Increasing the closed quotient improves voice quality after type I thyroplasty in patients with unilateral vocal cord paralysis: analysis using SPEAD program. J Voice 2008;22:751–5

56 SJ. Charous Novel technique of silastic implant carving for thyroplasty type I surgery. Otolaryngol Head Neck Surg 2005;133:629–30

57 N. Isshiki Progress in laryngeal framework surgery. Acta Otolaryngol 2000;120:120–7

58 J Selber , R Sataloff , J Spiegel , Y. Heman-Ackah Gore-Tex medialization thyroplasty: objective and subjective evaluation. J Voice 2003;17:8895

59 RA. Franco Adduction arytenopexy, hypopharyngoplasty, medialization laryngoplasty, and cricothyroid subluxation for the treatment of paralytic dysphonia and dysphagia. Oper Tech Otolaryngol Head Neck Surg 2012;23:164–72

60 MW Chester , MG. Stewart Arytenoid adduction combined with medialization thyroplasty: an evidence-based review. Otolaryngol Head Neck Surg 2003;129:305–10

61 FR Miller , GL Grady , JL. Netterville Arytenoid adduction in vocal fold paralysis. Oper Tech Otolaryngol Head Neck Surg 2001;10:3641

62 HM Tucker , J Wanamaker , M Trott , D. Hicks Complications of laryngeal framework surgery (phonosurgery). Laryngoscope 1993;103:525–8

63 CS Cotter , MA Avidano , MA Crary , NJ Cassisi , MM. Gorham Laryngeal complications after type 1 thyroplasty. Otolaryngol Head Neck Surg 1995;113:671–3

64 SL Halum , GN Postma , JA. Koufman Endoscopic management of extruding medialization laryngoplasty implants. Laryngoscope 2005;115:1051–4

66 JA Koufman , GN. Postma Revision laryngoplasty. Oper Tech Otolaryngol Head Neck Surg 1999;10:61–5

67 MR Lundeberg , PW Flint , LL Purcell , JS McMurray , CW. Cummings Revision medialization thyroplasty with hydroxylapatite implants. Laryngoscope 2011;121:9991002

68 ML. Harries Unilateral vocal fold paralysis: a review of the current methods of surgical rehabilitation. J Laryngol Otol 1996;110:111–16

69 B Kasterovic , M Veselinovic , S. Mitrovic Voice therapy and assistive techniques in voice disorders caused by unilateral vocal cord pareses. Med Pregl 2014;67:91–6

70 K Tsunoda , T Baer , S. Niimi Autologous transplantation of fascia into the vocal fold: long-term results of a new phonosurgical technique for glottal incompetence. Laryngoscope 2001;111:453–7

71 TM McCulloch , BT Andrews , HT Hoffman , SM Graham , MP Karnell , C. Minnick Long-term follow-up of fat injection laryngoplasty for unilateral vocal cord paralysis. Laryngoscope 2002;112:1235–8

73 TD Anderson , N. Mirza Immediate percutaneous medialization for acute vocal fold immobility with aspiration. Laryngoscope 2001;111:1318–21

74 AD Friedman , JA Burns , JT Heaton , SM. Zeitels Early versus late injection medialization for unilateral vocal cord paralysis. Laryngoscope 2010;120:2042–6

75 DG Sant'Anna , M. Mauri Head and neck and plastic surgery: a targeted problem and its solution. Use of the microdebrider for Reinke's edema surgery. Laryngoscope 2000;110:2114–16

76 K Tsunoda , K Kondou , K Kaga , S Niimi , T Baer , K Nishiyama Autologous transplantation of fascia into the vocal fold: long-term result of type-1 transplantation and the future. Laryngoscope 2005;115:110

77 JY Jang , G Lee , J Ahn , YI. Son Early voice rehabilitation with injection laryngoplasty in patients with unilateral vocal cord palsy after thyroidectomy. Eur Arch Otorhinolaryngol 2015;272:3745–50

78 HM. Tucker Simultaneous medialization and reinnervation for unilateral vocal fold paralysis. Oper Tech Otolaryngol Head Neck Surg 1993;4:183–5

79 HM. Tucker Combined surgical medialization and nerve-muscle pedicle reinnervation for unilateral vocal fold paralysis: improved functional results and prevention of long-term deterioration of voice. J Voice 1997;11:474–8

80 WF Su , YD Hsu , HC Chen , H. Sheng Laryngeal reinnervation by ansa cervicalis nerve implantation for unilateral vocal cord paralysis in humans. J Am Coll Surg 2007;204:6472

81 WT Lee , C Milstein , D Hicks , LM Akst , RM. Esclamado Results of ansa to recurrent laryngeal nerve reinnervation. Otolaryngol Head Neck Surg 2007;136:450–4

82 DK Chhetri , JH. Blumin Laryngeal reinnervation for unilateral vocal fold paralysis using ansa cervicalis nerve to recurrent laryngeal nerve anastomosis. Oper Tech Otolaryngol Head Neck Surg 2012;23:173–7

84 DK Chhetri , BR Gerratt , J Kreiman , GS. Berke Combined arytenoid adduction and laryngeal reinnervation in the treatment of vocal fold paralysis. Laryngoscope 1999;109:1928–36

85 JH Blumin , AL. Merati Laryngeal reinnervation with nerve-nerve anastomosis versus laryngeal framework surgery alone: a comparison of safety. Otolaryngol Head Neck Surg 2008;138:217–20

86 G Dursun , S Boynukalin , O Bagis Ozgursoy , I. Coruh Long-term results of different treatment modalities for glottic insufficiency. Am J Otolaryngol 2008;29:712

87 D Hajioff , H Rattenbury , S Carrie , P Carding , J. Wilson The effect of Isshiki type 1 thyroplasty on quality of life and vocal performance. Clin Otolaryngol Allied Sci 2000;25:418–22

88 CR Billante , J Clary , P Childs , JL. Netterville Voice gains following thyroplasty may improve over time. Clin Otolaryngol Allied Sci 2002;27:8994

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