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

The Isshiki type I thyroplasty medializes the membranous portion of the vocal fold. Since its introduction into this country more than 10 years ago, several authors have reported modifications of the Isshiki approach primarily for the purpose of speeding the operation and "simplifying" the procedure. The major modifications have included: (a) incision, versus retraction, of the strap muscles; (b) removing the window external perichondrium; (c) varying the placement and size of the window and prosthesis; (d) removal of the window cartilage; (e) fiberoptic versus nonvisualization of the larynx intraoperatively; (f) incision of the inner perichondrium; and (d) use of silastic block substitutes. The principles of Isshiki's original technique will be reiterated in the ongoing discussion, and the reasons for not modifying certain aspects of the technique will be examined from the standpoint of complications and negative impact that manifest when modification is done.