He said it’s a good idea to try to move expediently to “beat edema,” because once that happens it can affect sound quality and may even lead to underestimating the implant size. He added that, although visualizing the glottis is important during the procedure, it’s a big help to have a “good ear.” Sometimes the folds don’t close, but the sound is good. In other cases, the reverse is true. “You want to be able to tell what sounds best as you fashion your implant—improvement can be subtle,” he said.
Explore This IssueNovember 2016
Sometimes the Type 1 thyroplasty isn’t enough, and a patient might be a candidate for arytenoid adduction, said Adam Klein, MD, director of Atlanta’s Emory Voice Center. The Type 1 thyroplasty adjusts the horizontal position of the vocal fold, but an arytenoid adduction—by rotating the vocal fold cartilage back into place—adjusts the vertical position as well.
A consensus still exists that some imaging should be done to rule out mass lesions along the recurrent laryngeal nerve in most cases of vocal fold paralysis. — David Francis, MD, MS
A large glottal gap is often a good indicator that this procedure could be helpful. “When you see the arytenoid is way out laterally, those are the patients we look at and say, ‘This patient has a higher likelihood of requiring an arytenoid procedure.’”
But these are not always easy procedures, Dr. Klein advised. Patients need to be able tolerate the sedation, and previous surgery or radiation to the neck may make the patient unsuitable for an arytenoid repositioning procedure. The vocal demands of the patient may also factor into the decision.
During the surgery, sedation should be such that the patient is awake to use his voice, and he should be allowed to moisten his throat. Dr. Klein warned that muscle tension dysphonia and post-intubation phonation problems could arise during surgery. He also cautioned that the procedure is just a “static geometric solution for a dynamic problem” and that patients should go in with reasonable expectations. Dr. Klein advises patients that he will get their voices as near normal as possible, but that they might still notice some limits.
Thomas Collins is a freelance medical writer based in Florida.