Medialization Thyroplasty with Tensor Fascia Lata for Immunocompromised or Irradiated Patients

Medialization thyroplasty (MT) for unilateral vocal fold paralysis (UVFP) is commonly performed with foreign implants that risk inflammation and extrusion. We present our experience using autologous tensor fascia lata (TFL) implants for MT in immunocompromised patients and those with a history of neck radiation.

Patients who underwent MT and TFL harvesting between April 2017 and September 2022 with at least one follow-up were included in a retrospective case series. Comorbidities, treatment history, complications, Voice Handicap Index-10 (VHI-10), Eating Assessment Tool-10 (EAT-10), preoperative and postoperative fiberoptic laryngoscopy videos, and outcomes at follow-up were collected.

Fifteen patients met the selection criteria, including 12 women and three men (median age = 57 and 43 years). Median follow-up was 19 months (Interquartile Range [IQR] = 3.5-25.5). Medical histories include patients with cancer (seven thyroid cancers, three Hodgkin's lymphomas, two breast cancers on long-term chemotherapy, one metastatic renal cell carcinoma) and two patients who underwent lung transplantation. Pertinent surgical history includes one parathyroidectomy, eight thyroidectomies of which three experienced intraoperative recurrent laryngeal nerve transections, and two patients with existing UVFP. Eight patients received external beam radiation to the neck, and three patients received radioactive iodine (RAI). Seven received one vocal cord injection. Risk factors included diabetes (1), immunosuppression (6), and anticoagulation (2). None were active smokers. There were no surgery-related readmissions within 30 days or long-term complications such as extrusion or infection. Patients reported subjectively improved voice (n = 11) and swallowing (n = 8) at follow-up. One had difficulty projecting and received two hyaluronic acid injections with improvement. Three reported persistent dysphagia. Two had pain for 2 weeks at the harvest site. Two patients reported improved VHI-10 scores at their postoperative visit, and three patients had improved EAT-10 scores. Blinded assessments of preoperative and postoperative fiberoptic laryngoscopy videos, independently carried out by two certified speech-language pathologists, showed significant improvement in gross glottic gap closure, with a mean follow-up of 24.3 ± 16.9 months (P = 0.025).

This pilot study suggests that the novel approach of MT using autologous TFL appears to be safe and potentially effective for UVFP patients with a history of external beam radiation of the neck or immunosuppression.