PubMed · 10030824
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T E Havas, D Veivers, R J Mobbs. 1999. Pseudo Rontals tenotomy.. https://doi.org/10.1046/j.1440-1622.1999.01471.x
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Medialization laryngoplasty has become the new gold standard for the permanent management of patients with vocal fold paralysis and paresis. This article reviews the conceptual developments of the diagnosis and management of patients with vocal fold paresis and paralysis. We identify the specifics of operative decision-making as well as surgical complications associated with medializationlaryngoplasty. The role of revision surgery is detailed. We suggest a standardized evaluation using both objective and subjective data for analysis of surgical outcomes.
OBJECTIVE: Medialization thyroplasty (MT) and arytenoid adduction (AA) are effective treatments for medializing the paralyzed vocal cord, but indications and benefits of each procedure are controversial. We performed a formal evidence-based review to answer this question: In patients with unilateral vocal cord paralysis, does AA combined with MT significantly improve subjective and objective voice outcomes compared with MT alone?Study design We performed a MEDLINE literature search using specific search terms to identify pertinent articles, which were reviewed and graded according to the evidence quality. RESULTS: We identified 219 potentially pertinent articles; detailed review yielded 10 studies for further analysis. Only 3 studies directly compared MT with AA plus MT: overall, there was no clear benefit in subjective or objective outcomes for AA plus MT. CONCLUSIONS: Very limited grade C evidence indicates no clear benefit, or lack of benefit, in subjective or objective outcomes if AA is added to MT, compared with MT alone.
The purpose of this paper was to compare the vibration of the vocal fold submitted to Isshiki thyroplasty type I (TPI) to that of the contralateral one adducted by the arytenoid rotation (AR) technique. The vocal folds of ten human fresh excised larynges were medialized by TPI on one side and by rotation of the arytenoid on the contralateral side. Laryngeal vibration was artificially produced and was recorded by videostroboscopy. The images were subjectively and objectively analyzed. Subjective analysis included periodicity of vibratory cycles, features of the mucosal wave present on the TPI side, amplitude of vibration, and profile of free border of each vocal fold during the opening phase. Objective analyses were carried out on frame-by-frame digitalized images to determine amplitudes of vibrations and phase differences between the folds in three glottic regions (anterior, middle, and posterior). Subjective analysis revealed regular periodicity in 100% of the larynges, a decrease in the mucosal wave on the TPI side in 70%, reduction in amplitude in 30%, and a sigmoid profile of the free border on the TPI side in 80%. Objective analysis showed mean amplitude in the posterior glottic region on the TPI side significantly larger than that on the arytenoids rotation side and phase asymmetry in 90% of the larynges.