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Hydroxylapatite laryngeal implants for medialization. Preliminary report
C W Cummings1, L L Purcell, P W Flint
1Department of Otolaryngology-Head Neck Surgery, Johns Hopkins University, Baltimore, Maryland.
The Annals of Otology, Rhinology, and Laryngology
|November 1, 1993
Summary
Preformed hydroxylapatite implants offer an effective solution for vocal fold medialization surgery, improving patient voice function. This method allows for quick size and position assessment, enhancing surgical outcomes.
Area of Science:
- Otolaryngology
- Biomaterials Science
- Surgical Innovation
Background:
- Vocal fold motion impairment significantly impacts patient quality of life.
- Laryngeal medialization surgery aims to restore vocal fold function.
- Current techniques require precise, individualized implant selection.
Purpose of the Study:
- To evaluate the efficacy of preformed hydroxylapatite (HA) laryngeal implants for medialization thyroplasty.
- To assess a novel instrumentation system for rapid implant sizing and positioning.
- To report preliminary outcomes and complications associated with this technique.
Main Methods:
- A surgical window was created in the thyroid ala using a standard fenestra template.
- Preformed HA prosthesis templates were used to determine optimal implant size and position.
- Corresponding HA implants were inserted and secured with HA shims.
- Data collected from 39 patients (35 for paralysis, 4 for deficits/bowing).
Main Results:
- Subjective improvement reported by 89% (31/35) of patients with vocal fold paralysis.
- Objective voice function improvement demonstrated in 87% (13/15) of patients with complete pre- and post-operative measurements.
- Complications included one implant extrusion and one case of airway obstruction due to edema.
Conclusions:
- Prefabricated hydroxylapatite implants are effective for medialization thyroplasty.
- The system allows for readily available implant selection and rapid intraoperative assessment.
- Improved implant stabilization was achieved using hydroxylapatite shims, suggesting a promising surgical approach.