Get access

Thyroplasty Type I With Montgomery Implant among Native French Language Speakers with Unilateral Laryngeal Nerve Paralysis

Authors

  • Ollivier Laccourreye MD,

    Corresponding author
    1. Department of Oto-rhino-laryngology–-Head and Neck Surgery, Hôpital Européen Georges Pompidou, University Paris V, Assistance Publique des Hôpitaux de Paris, Paris, France.
    • Dr. Ollivier Laccourreye, Department of Oto-rhino-laryngology–-Head and Neck Surgery, Hôpital Européen Georges Pompidou, 20-40 rue Leblanc, 75015, Paris, France.
    Search for more papers by this author
  • Louay El Sharkawy MD,

    1. Department of Oto-rhino-laryngology–-Head and Neck Surgery, Hôpital Européen Georges Pompidou, University Paris V, Assistance Publique des Hôpitaux de Paris, Paris, France.
    Search for more papers by this author
  • F Christopher Holsinger MD,

    1. Department of Oto-rhino-laryngology–-Head and Neck Surgery, Hôpital Européen Georges Pompidou, University Paris V, Assistance Publique des Hôpitaux de Paris, Paris, France.
    Search for more papers by this author
  • Stéphane Hans MD, PhD,

    1. Department of Oto-rhino-laryngology–-Head and Neck Surgery, Hôpital Européen Georges Pompidou, University Paris V, Assistance Publique des Hôpitaux de Paris, Paris, France.
    Search for more papers by this author
  • Madeleine Ménard MD,

    1. Department of Oto-rhino-laryngology–-Head and Neck Surgery, Hôpital Européen Georges Pompidou, University Paris V, Assistance Publique des Hôpitaux de Paris, Paris, France.
    Search for more papers by this author
  • Daniel Brasnu MD

    1. Department of Oto-rhino-laryngology–-Head and Neck Surgery, Hôpital Européen Georges Pompidou, University Paris V, Assistance Publique des Hôpitaux de Paris, Paris, France.
    Search for more papers by this author

  • This study was supported in part by the Fulbright U.S. Scholars Grant Program (f.c.h.), administered by the commission Franco-Américaine D'échanges Universitaires et Culturels, Paris, France, the Council for International Exchange of Scholars, Washington, DC.

    Dr. Louay El Sharkawy benefited from the Progrès 2000 traveling fellowship and is currently working at Cairo University Hospitals, Kasr el Aini School of Medicine, Cairo University, Cairo, Egypt. Dr. Holsinger now currently serves in the Department of Head and Neck Surgery, the University of Texas M.D. Anderson Cancer Center, Houston, Texas.

Abstract

Objective: To document the long-term results achieved with the Montgomery implant in 96 French speakers with a unilateral laryngeal nerve paralysis (ULNP).

Study Design: Retrospective series, inception cohort of 96 patients.

Methods: Data regarding morbidity and functional results were obtained at regular visits to our clinic. All patients were followed for a minimum of 6 months or until death. Forty-two patients had a minimum of 12 months of follow-up. Early in the study, 36 patients were prospectively recorded under similar conditions before placement of the Montgomery implant and at 1, 3, 6, and 12 months postoperatively.

Results: None of the 96 patients died in the immediate postoperative period. The perioperative course was unremarkable in 94.8% of cases. Perioperative problems included failure to obtain a satisfactory phonatory result in three patients, difficulty to stabilize the implant posteriorly in one patient, and fracture of the inferior rim of the thyroid cartilage window in another patient. The primary immediate postoperative problem (within the first postoperative month) was laryngeal dyspnea, noted in four patients. According to the patient's subjective assessment, speech and voice was always improved in the immediate postoperative period. However, three patients had secondary degradation of speech and voice. Revision surgery under local anesthesia resulted in a 97.9% ultimate speech and voice success rate. According to the patient's subjective assessment, adequate swallowing in the immediate postoperative period was achieved in 94.2% of cases that had swallowing problems preoperatively. A significant statistical increase in the duration parameters (phonation time, phrase grouping, speech rate) together with a statistical significant decrease in both the jitter and shimmer values was noted when comparing the preoperative and the postoperative values at 1 month. Analysis of the evolution of the speech and voice parameters at 1, 3, 6, and 12 months postoperatively showed a significant decrease in the fundamental frequency and noise-to-harmonic ratio values but did not demonstrate any significant differences for the other speech and voice parameters.

Conclusions: From the reported data, we conclude that the type I thyroplasty with Montgomery implant insertion is a safe and reproducible method to treat ULNP. Furthermore, this system achieves very good and stable phonatory results. Finally, the use of this technique and implant system appears safe in patients from various cultures with ULNP from a variety of causes and severe comorbidity. Over the past decade at our department, this procedure progressively replaced the use of the intracordal injection of autologous fat injection that was initially advocated in patients with ULNP.

Ancillary