Thyroplasty as primary and adjunctive treatment of glottic insufficiency

This study addresses the role of medialization thyroplasty in a variety of vocal fold pathological conditions manifested by glottic insufficiency. In this series, most patients had preceding or concurrent phonosurgical procedures. Success of surgery was determined by subjective, audioperceptual judgments, acoustic analysis, and vocal function measures. Vocal fold pathology played a greater role in determining success than did the presence or absence of adjunctive surgical procedures. Thyroplasty Type I was effective in treating glottic insufficiency in patients previously treated with various augmentation procedures as well as in those undergoing simultaneous reinnervation and arytenoid adduction. Technical factors predisposing to complications included violation of inner thyroid cartilage perichondrium, small shim size, sacrifice of cartilagenous window, and mucosal penetration. Thyroplasty should be considered as a primary or adjunctive treatment of patients with glottic insufficiency, especially when preservation of membranous vocal fold structure is of primary importance.