Anterior and posterior medialization (APM) thyroplasty

Area of Science:

• Otolaryngology
• Speech and Hearing Sciences

Background:

• Unilateral vocal fold paralysis often causes dysphonia.
• Medialization laryngoplasty may be limited by wide posterior glottal gaps.
• A need exists for improved surgical techniques for posterior glottal gap closure.

Purpose of the Study:

• To introduce and evaluate a novel surgical technique, anterior and posterior medialization (APM) thyroplasty.
• To assess the efficacy of APM thyroplasty in medializing both membranous and cartilaginous portions of the paralyzed vocal fold.
• To determine the impact of APM thyroplasty on voice quality and glottal closure.

Main Methods:

• APM thyroplasty was performed on six patients with unilateral vocal fold paralysis.
• Preoperative and postoperative evaluations included acoustic analysis and video laryngoscopy.
• Patient subjective satisfaction with voice outcomes was assessed.

Main Results:

• All six patients reported subjective voice improvement post-surgery.
• APM thyroplasty successfully medialized the membranous and cartilaginous vocal fold portions.
• Postoperative voice analysis revealed prolonged phonation times and decreased voice perturbations.

Conclusions:

• APM thyroplasty offers direct medialization of the paralyzed vocal fold, addressing both membranous and cartilaginous segments.
• The technique effectively corrects vertical mismatch between vocal folds.
• APM thyroplasty is particularly indicated for lateralized vocal fold paralysis but less so for higher-positioned paralyzed folds.