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Titanium bridge wing fracture after type II thyroplasty for adductor spasmodic dysphonia: No adverse effect on
Marin Yoshida1, Kazuhiro Nakamura2, Kana Suzuki2
1Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Japan; Neurosurgery and Otorhinolaryngology, Yoshida Clinic, Japan.
Objective:
In Type II thyroplasty (TP2) for adductor spasmodic dysphonia (AdSD), titanium bridges are widely utilized to stabilize the laryngeal framework. However, postoperative wing fractures have been increasingly recognized. This study aimed to determine the incidence of titanium bridge wing fractures and to assess their impact on neck symptoms and long-term vocal function.
Methods:
This retrospective observational study included 37 patients who underwent TP2 by same surgeon between 2008 and 2021 and attended follow-up evaluations between 2022 and 2023. Cervical radiographs were employed to assess wing fracture status. Cervical radiographs were independently reviewed by two otolaryngologists to assess wing fracture status. Patients were categorized into fracture and non-fracture groups and compared regarding demographic characteristics, neck symptoms, follow-up duration, and voice outcomes. Voice assessment included the Voice Handicap Index (VHI), Mora method, and acoustic parameters (Jitter and Shimmer indices). Statistical analyses were performed using Prism (GraphPad), with significance set at p < 0.05.
Results:
The study included 5 males and 32 females (mean age: 44.1 ± 13.3 years). Wing fractures occurred in 8 of 15 (53%) old-type and 9 of 22 (41%) new-type titanium bridges, resulting in an overall fracture rate of 46%. Notably, all fractures were localized to the wing portion of the bridge, with no displacement of the main bridge segment. Crucially, neither deterioration in vocal function nor neck symptoms were observed in the fracture group. Furthermore, no significant differences were identified in VHI, Mora method, or acoustic parameters between the two groups at any time point. In the new-type group, a significant correlation was found between longer implantation duration and the occurrence of wing fractures (p = 0.02).
Conclusion:
Titanium bridge wing fractures after TP2 did not adversely affect postoperative vocal function. Because fractures were strictly confined to the wing portion and did not compromise the bridge segment responsible for vocal fold lateralization, functional stability was maintained. Our findings suggest that routine reoperation is unnecessary if voice quality remains stable.
