What are the success and complication rates of laryngeal framework surgery (LFS), including medialization laryngoplasty (ML) and arytenoid adduction (AA)?
Background: Since its introduction in the 1970s, LFS, comprised of ML and AA, has been increasingly utilized for vocal fold paralysis and glottal incompetence. Little is known, however, about the incidence of ML/AA surgery nationwide or its success and complications.
Study design: A 25-item questionnaire was mailed to 6,644 board-certified otolaryngologists. Their responses were compared to the findings of a 1998 study to assess trends over time. The 1998 study had concentrated primarily on ML as an indicator of experience with LFS.
Setting: Department of Otolaryngology and the School of Dental Medicine, University of Pittsburgh, Pittsburgh, Penn.
Synopsis: Of the response rate of 25.7 percent (n=1,707), 63 percent perform ML and/or AA, representing 29,748 procedures. Experience with Silastic medialization implants was shown to have decreased over time, while utilization of other materials has increased. The overall complication rate was 15 percent, including 0.8 percent implant extrusion and 6 percent in revision rates. Compared to 1998, there was an overall relative decrease in complication rates with increased experience with ML. The most common revision was placement of a larger implant. Airway compromise requiring intervention was observed in 2.2 percent and suboptimal voice outcome in 4 percent. While the study encompassed more than double the procedures reported in 1998, the number of surgeons performing these surgeries has not significantly increased. Study limitations were possible physician selection bias and the reliance on physician memory for survey input.
Bottom line: LFS plays an increased role as a treatment modality for vocal fold paralysis, with complication rates only slightly increased and the need for revision surgery unchanged as compared to 1998.
Citation: Young VN, Zullo TG, Rosen CA. Analysis of laryngeal framework surgery: 10-year follow-up to a national survey. Laryngoscope. 2010;120(8):1602-1608.
—Reviewed by Sue Pondrom