Arthur Jones
Unilateral vocal fold paralysis can have a significant impact on quality of life due to glottic insufficiency which can result in dysphonia, aphonia, dyspnoea, decreased cough strength, and dysphagia. Often it manifests alongside concurrent medical conditions such as stroke, malignant disease or iatrogenic injury at the time of surgery. Our institution runs a dedicated voice clinic in close partnership with specialist speech pathology which allows a multidisciplinary approach to patient care. For those that fail diet modification and conservative measures, various medialisation procedures are available including filler injection, type 1 thyroplasty with or without arytenoidopexy and recurrent laryngeal nerve re-innervation. We present our experience and outcomes of type I thyroplasty performed at our institution over the past eleven years. A recurrent laryngeal nerve may be sacrificed in patients undergoing intrathoracic surgical treatments for cancer. Postoperative vocal fold paralysis can result in a decreased cough, secretion retention, aspiration, and potentially life-threatening pneumonia. This study looks back at the experiences of 23 patients who had type I thyroplasty within the first two weeks (acute) after thoracic surgery at our hospital. The most prevalent disease was primary lung cancer (n = 16). The most common surgical procedures were upper lobectomy (n = 9) and pneumonectomy (n = 7). Silicone medialization was used alone (n = 11) or in combination with arytenoid adduction (n = 12). There were no serious problems following the surgery. Hoarseness (86%) was improved, as was dyspnea (72%), dysphagia (50%) and aspiration (79%). In the majority of patients, pulmonary status improved after vocal fold medialization, as evidenced by the requirement for therapeutic bronchoscopy in the postoperative term. In this high-risk patient population, Type I thyroplasty for vocal fold paralysis in the acute phase following thoracic surgery is well tolerated and linked with improved patient outcome with no postoperative deaths. Defective glottic closure caused by a deficiency in vocal fold closure is most typically caused by unilateral vocal fold paralysis.
