Thyroplasty and Arytenoid Adduction

Thyroplasty

Thyroplasty is a surgery performed in the operating room to improve the voice. Thyroplasty is usually performed for treatment of patients with conditions where vocal folds do not properly meet to produce sound such as:

Vocal fold paralysis
Vocal fold paresis
Presbylarynges – the aging larynx
Defect in the larynx after cancer treatment

Thyroplasty is performed in the operating room with a patient under ‘twilight anesthesia’ or sedation. A cut is made on the skin overlying the area of the thyroid cartilage in a horizontal direction. The strap muscles, which are layered overlying the thyroid cartilage, are moved. A small hole is made in the thyroid cartilage and a small implant is placed to move the vocal fold to the midline. Implants such as GORE-TEX or silastic are commonly used. This surgery may be combined with an arytenoid adduction in which the cartilage tethering the vocal fold is manipulated to enhance results. During the portion of the procedure in which the vocal fold is moved, the patient is awoken and asked to speak so that the vocal fold may be placed in an optimal position.

Patients are typically observed in the hospital overnight, and are usually asked to take at least a week off from work. Patients follow up with the physician after surgery to evaluate the skin and efficiacy of surgery.

Arytenoid Adduction

An arytenoid adduction is procedure that is performed to rotate the position of the arytenoid and vocal fold in treatment of unilateral vocal fold paralysis. The vocal fold is tethered on the arytenoid cartilage. During an arytenoid adduction, the cartilage is positioned to move the vocal fold to a position for optimal voice production. Arytenoid adduction is performed with thyroplasty is used to medialize the vocal fold.

Aryenoid adduction is performed in the operating room with a patient under ‘twilight anesthesia’ or sedation. A cut is made on the skin overlying the area of the thyroid cartilage in a horizontal direction. The strap muscles, which are layered overlying the thyroid cartilage are moved. The thyroid cartilage is manipulated and sometimes partially resected to allow identification of the arytenoid cartilage. It is moved and repositioned to medialize the vocal fold. Patients are awoken during this part of the surgery to “test” the new vocal fold position. The vocal fold is then supported with a thyroplasty implant such as Gore-tex or silastic.

Patients are typically observed in the hospital overnight, and are asked to take at least a week off from work. Patients follow up with the physician after surgery to evaluate the skin and efficacy of surgery. Arytenoid adduction is beneficial for some, but not necessarily all patients with vocal fold paralysis.