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Learning curve of medialization thyroplasty using a Montgomery™ implant
G Desuter1, S Henrard, D Boucquey
1Otolaryngolgy, Head and Neck Surgery Department, Voice and Swallowing Clinic, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 avenue Hippocrate, 1200, Brussels, Belgium, gauthier.desuter@uclouvain.be.
Surgeon experience significantly reduces operative time for medialization thyroplasty (MT). However, increased experience did not correlate with improved voice outcomes like maximum phonation time or reduced vocal jitter.
Area of Science:
- Otolaryngology
- Laryngeal Surgery
- Voice Restoration
Background:
- Type I thyroplasty, or medialization thyroplasty (MT), is a recognized treatment for glottic incompetence and vocal fold palsy.
- Concerns exist regarding the necessary surgeon experience for optimal voice outcomes in MT procedures.
- The Montgomery® hard silicone implant is a common tool for MT.
Purpose of the Study:
- To evaluate the learning curve associated with medialization thyroplasty (MT) using the Montgomery® implant.
- To determine the relationship between surgeon experience and objective voice outcome measures.
Main Methods:
- A retrospective study of 36 patients undergoing MT, divided into consecutive experience groups.
- Analysis of operative times (OT) and acoustic/aerodynamic outcome improvements (δ).
- Statistical analysis using Anova, Kruskal Wallis, and Chi-squared tests.
Main Results:
- Operative times (OT) significantly decreased with increasing surgeon experience (Group 1: 90.5 min, Group 2: 71.5 min, Group 3: 56 min; p < 0.001).
- Objective voice outcome measures (MPT, ESGP, Shimmer, Jitter) did not show significant improvement with experience (p > 0.376).
- The Voice Handicap Index (VHI) showed significant improvement in Group 2 compared to Groups 1 and 3 (p = 0.005).
Conclusions:
- Surgeon experience demonstrably shortens operative time for medialization thyroplasty (MT).
- This study found no significant correlation between surgeon experience and improvements in objective voice quality parameters.
- While VHI improved with experience, further research is needed to optimize objective voice outcomes in MT.
