Audit of effectiveness of cartilage sparing medialisation thyroplasty

Dulani Mendis, Kate Young, Deepak Mehta and Sharat Mohan

Medialisation thyroplasty (type I) is a surgical option for patients with vocal fold paralysis presenting with dysphonia and/or aspiration. Our audit will analyse the technique of thyroid cartilage preservation.
Objective: Vocal fold paralysis was confirmed (glottic closure) by assessment in our voice clinic. Objective assessment was made by videostroboscopy and maximum phonation time (MPT). Subjectively (i) voice quality was assessed by an experienced speech and language therapist and (ii) the completion of a patient satisfaction (questionnaire).
Study design: Second-cycle of a retrospective and prospective audit of patients who underwent medialisation thyroplasty at Derby Royal Infirmary from 2003-2006. Following on from the first cycle (1998-2002), which involved the technique of thyroid cartilage removal, which was associated with three implant extrusions.
Methods: 33 consecutive patients with unilateral vocal fold paralysis were included, (18 males:15 females); age range of 24-87 years (median age 62). All patients were asked about a subjective improvement in voice (Likart scale) and medical records were checked for indications and complications. Follow-up ranged from 3 to 9 months.
Results: All patients had a subjective improvement in voice quality and reported satisfaction with voice outcome. 30 out of 33 patients had an improvement in MPT (p-value <0.001). Two patients were aphonic pre-operatively and none post-operatively. None of the cases experienced implant extrusion and one case developed a localised wound infection.
Conclusions: Medialisation thyroplasty is a safe and effective operation for patients with unilateral vocal fold paralysis. Implant extrusion maybe avoided through thyroid cartilage preservation as discussed in this second-cycle audit.

¹Miss Dulani Mendis, ENT SpR West Midlands, B.Sc., DOHNS, DHMSA, MBBS, MRCS.
²Miss Kate Young, Speech and Language Therapist, BApp. Sci (Speech Pathology)
³Mr Deepak Mehta, Clinical Fellow Pediatric Otolaryngology, DLO, FRCS (ORL)
⁴Mr Sharat Mohan, ENT Associate Specialist, B.Sc., MS, FRCS I.[Oto], DLORCS (London)

Institutional affiliations:
¹Dept. ENT Surgery, University Hospital Coventry, Coventry CV2 2DX
²Dept. Pediatric Otolaryngology, Cincinnati Childrens Hospital, 3333 Burnet Avenue, Cincinnati, Ohio 45229-3039,USA
^3/4Dept. ENT Surgery, Derby Royal Infirmary NHS Foundation Trust, London Road,
DerbyDE1 2QY
Correspondence to: Miss D. Mendis
E-mail: dulanimendis@yahoo.com
Telephone: 024 769 64000 (Bleep 1896) Fax: 024 769 65613