Type I thyroplasty: pitfalls of modifying the Isshiki approach. How I do it

Area of Science:

• Otolaryngology
• Laryngeal Surgery
• Voice Restoration

Background:

• The Isshiki type I thyroplasty is a standard surgical technique for vocal fold medialization.
• Numerous modifications to the original Isshiki approach have been proposed over the past decade.
• These modifications primarily aim to reduce operative time and procedural complexity.

Purpose of the Study:

• To reiterate the core principles of the original Isshiki type I thyroplasty.
• To critically evaluate the impact of common modifications on surgical outcomes.
• To identify potential complications and negative consequences arising from procedural alterations.

Main Methods:

• Review of literature on modifications to the Isshiki type I thyroplasty.
• Analysis of reported surgical outcomes and complications associated with various modifications.
• Comparison of modified techniques against the principles of the original Isshiki approach.

Main Results:

• Major modifications include variations in muscle management, window creation, prosthesis placement, cartilage removal, visualization methods, and implant materials.
• The discussion will examine the rationale behind specific modifications and their clinical implications.
• Potential negative impacts and complications associated with these alterations will be highlighted.

Conclusions:

• Adherence to the original Isshiki technique's principles may be crucial for avoiding complications.
• Modifications, while intended to simplify, can introduce unforeseen negative consequences.
• A thorough understanding of the original technique is essential before considering procedural variations.