This research was supported by NIH grant 1-R01 DC05522 from the National Institute of Deafness and other Communication Disorders.
A-P positioning of medialization thyroplasty in an excised larynx model†
Article first published online: 23 FEB 2009
Copyright © 2009 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 119, Issue 3, pages 591–596, March 2009
How to Cite
Czerwonka, L., Ford, C. N., Machi, A. T., Leverson, G. E. and Jiang, J. J. (2009), A-P positioning of medialization thyroplasty in an excised larynx model. The Laryngoscope, 119: 591–596. doi: 10.1002/lary.20122
- Issue published online: 23 FEB 2009
- Article first published online: 23 FEB 2009
- Manuscript Accepted: 12 AUG 2008
- excised larynx;
- voice assessment
Posterior positioning of medialization thyroplasty provides the best acoustic and aerodynamic outcomes.
Ex vivo excised canine larynx.
Unilateral thyroplasty windows were cut in the thyroid cartilages of 10 excised canine larynges. Each larynx was mounted on an artificial lung and the vocal fold opposite the thyroid window was adducted by medializing its arytenoid cartilage. Then, medialization thyroplasty was simulated with a probe placed anterior, central, and posterior in the thyroid window. The glottal area, airway reduction, medialization force, phonation threshold pressure and flow, aerodynamic power, intensity, efficiency, jitter, shimmer, and signal-to-noise ratio (SNR) were measured at each medialization position.
Posterior medialization probe placement minimized the glottal area, provided the best voice as determined by perturbation measures and SNR, reduced the work of phonation, and increased efficiency. Anterior and middle probe placement minimized the work of phonation but provided only modest gains in sound quality and decreased sound intensity. Medializing the vocal fold with posterior probe placement required twice as much force as central and anterior probe placement.
The results suggest that posterior medialization provides the greatest improvement in acoustic parameters and efficiency in patients who can tolerate the airway reduction. Middle and anterior medialization can decrease work of phonation, but in this experiment objective improvement in sound quality was limited. Subtle changes in displacement shim contour, especially in middle and anterior locations, have a substantial impact on voice outcome, affirming the value of intraoperative voice assessment. Laryngoscope, 119:591–596, 2009