Vocal Fold Augmentation: Medialisation Thyroplasty
What is Medialisation Thyroplasty?
Medialisation Thyroplasty (MT) is a procedure in which one of both of the vocal folds is/are augmented by placing an implant into the vocal fold. If both vocal folds are augmented this is called a bilateral medialisation thyroplasty. I prefer to use a strip of GoreTex which is packed into the larynx through an opening in the main cartilage of the larynx - the thyroid cartilage. This is a permanent treatment for augmentation of the vocal folds, although the implant can be removed or changed in the future if required.
MT is carried out in the operating room in hospital. I usually perform the procedure with local anaesthetic (LA) and intravenous (IV) sedation, although sometimes a general anesthetic is used.
How is Medialisation Thyroplasty Performed?
You are brought into the operating room and lie flat on the operating room bed. The anaesthetist puts in an IV line and gives you IV sedation. This makes you very sleepy, but you are not completely asleep. I then draw a small incision line (approximately 5cm) over the lower part of the larynx. Local anaesthetic is then injected into the skin around the incision line. The neck is then prepared with antiseptic and drapes are placed on the neck.
An incision is made in the skin, and the muscles over the larynx are separated to expose the larynx. A small hole (called a window) is created in the cartilage on the side being augmented using a drill. If augmentation of both vocal folds is required windows are created on both sides of the cartilage.
After the window has been created, some anaesthetic spray is placed in the nose and a flexible endoscope is passed through the nose into the throat to examine the vocal folds from the inside. This allows me to check the positioning of the implant, and to check that the correct amount of implant has been used. The sedation is also reduced so that you are able to talk with me. I ask you to speak and by listening to your voice (as well as looking at the vocal folds with the endoscope) I am able to ensure that the positioning and the volume of the implant are correct.
If your vocal fold is paralysed an additional procedure called an arytenoid adduction is sometimes performed at the same time as the medialisation thyroplasty. Arytenoid adduction is a procedure in which the smaller arytenoid cartilage at the back of the vocal fold is repositioned. This is achieved by creating a second window in the back part of the thyroid cartilage to allow a suture to be placed through the arytenoid cartilage.
The muscles of the neck are then brought together, and the skin incision is closed using absorbable sutures that are buried under the skin. A surgical drain is usually not required.
From the operating room you are taken to the recovery room and then to the ward for an overnight stay. You will be discharged home the next day with pain relievers and antibiotics for one week. You may eat and drink normally, although most people have mild discomfort with swallowing. No voice rest is required.
Dr David Vokes