Migration of the anterior segment following anterior commissure advancement: a case report

A 53-year-old man with severe vocal fold atrophy underwent bilateral type 1 thyroplasty and anterior commissure advancement. Postoperatively, he developed a strained voice with less projection and volume than prior to surgery. This was verified by objective assessment of vocal function. Videoendoscopy revealed bilateral false vocal fold fullness and blunting of the anterior commissure. Magnetic resonance imaging demonstrated cephalic migration of the posterior ends of the implants and retrusion of the anterior commissure segment. Surgical exploration revealed that the type 1 implants had rotated and buckled. The anterior commissure segment was rotated and displaced inferiorly, and its inferior surface was tethered to the cricoid by scar tissue. The implants were removed, the anterior segment was repositioned and rigidly fixed, and bilateral lipoinjection performed. Vocal function was significantly improved, and endoscopy revealed normal tension and length of the vocal folds and restoration of the anterior commissure. This case demonstrates the importance of stable fixation during laryngeal framework surgery.