S198 – Muscle Pedicle Thyroplasty for Difficult or Revision Cases

Abstract

Objectives

1) Describe a modification of the type I thyroplasty procedure of Isshiki, incorporating a pedicled muscle flap which is rotated through the thyroid cartilage window into a pocket lateral to the thyroarytenoid muscle. The muscle flap is used to replace or augment an alloplastic implant. 2) Be able to understand the applications and indications for this procedure.

Methods

Our series describes 6 patients undergoing primary or revision thyroplasty since January 2006. In primary cases, the muscle pedicle was utilized after initial dissection resulted in an injury to the endolaryngeal mucosa, or to augment an implant that did not produce adequate medialization. In the revision cases, the muscle pedicle was utilized to replace a Silastic implant at the time of removal. Pre-operative and postoperative videostroboscopy was performed on all patients.

Results

Postoperative videostroboscopy revealed satisfactory glottic closure in all 6 patients between 1 and 3 months after their operations.

Conclusions

The procedure of muscle pedicle thyroplasty provides adequate glottic closure in cases of revision thyroplasty and in cases where it was used to augment another implant. It represents an alternative medialization technique in difficult and unusual cases, or when an alloplastic implant is contraindicated. Long-term durability of the medialization is not assessed in this series.