Type I + III Montgomery Thyroplasty for Post-Cordectomy Dysphonia

Post-cordectomy dysphonia is a persistent functional problem that can seriously affect quality of life. Although Montgomery medialization thyroplasty (type I) is a well-established treatment option for vocal cord paralysis, its application to post-oncological glottic defects associated with laryngeal retrusion (type III thyroplasty) requires technical adaptations that have not been systematically described.

We present an illustrated description of a combined type I and III Montgomery thyroplasty performed on two patients with severe post-cordectomy dysphonia. The technique involves retracting the laryngeal structure (type III thyroplasty), followed by the creation of a custom-made cartilaginous window and the placement of an implant (type I thyroplasty), under intraoperative fibroscope monitoring. Functional outcomes were assessed using the Unilateral Vocal Fold Paralysis-10 (UVFP-10) questionnaire, maximum phonation time (MPT), and the GRB perceptual scale.

We have operated on two patients following this method. Both of them demonstrated improvement in voice-related quality of life as measured by the UVFP-10 questionnaire: pre/post scores 16 to 5, and 26 to 21 for both cases. MPT improved from 7 to 20 seconds and from 3 to 6 seconds. No complications were recorded.

The combined type I + III thyroplasty represents a feasible laryngeal framework adaptation for selected fibrotic post-cordectomy defects, demonstrating preliminary technical feasibility and functional improvement.