Thyroplasty

This presentation discusses medialization thyroplasty using gortex

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Medialization Thyroplaty using
Gor-Tex

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Vocal fold paralysis
Rather common
problem
Causes speech
problems (Wasting of
voice)
Aspiration – If the
opposite cord
compensates
inadequately

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Management modalities
Voice therapy
Cord injection – Teflon, fat, collagen
Medialization thyroplasty using Teflon / Gor-Tex
Re-innervation techniques (early stages)
Gor-Tex was first used as an implant material for
medialization by Hoffman and McCullouch in
May 1996

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Indications for medialization
thyroplasty
Unilateral vocal fold immobility due to paralysis /
paresis / atrophy
Unilateral vocal fold scarring / soft tissue loss
In select cases of Parkinsonism with vocal fold
atrophy
In patients who aspirate due to vocal fold
paralysis without the opposite cord
compensating adequately

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Contraindications
Previous history of irradiation
Malignant lesions involving larynx
Poor abduction of contralateral vocal fold as this
could compromise the airway
Patients with poor pulmonary reserve

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Advantages of Gor-Tex
Gor-Tex is expanded
polytetrafluroethylene
It is malleable
Its position can easily
be adjusted via the
thyroid cartilage
window
Can easily be inserted
via a small opening
Reversible

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Advantages of Gor-Tex (contd)
The procedure has very little complications
Creates less oedema than silastic hence over
correction is not a possibility
Quality of voice is pretty good

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Procedure
Performed under local
anesthesia
Horizontal skin crease
incision starting at the
midportion of thyroid
cartilage extending to
the paralysed side
Strap muscles are
separated and held
apart by an umbilical
tape

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Thyroid cartilage cuts
Tracheal hook is used at the level of thryoid
prominence to pull the cartilage medially
Thyroid perichondrium is incised in the midline
and extended laterally
Cricoid laminae is skeletonized up to the level of
cricothyroid membrane on the paralyzed side

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Dimensions of cartilage cuts
Size of the cartilage window – 5mmx10mm
Lower border of window should be atleast 3 mm
above cricothryoid membrane
Anterior border should be about 8 mm posterior
to midline
Fissure burr could be used to create the window

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Cartilage cuts

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Inner perichondrium
Inner perichondrium is elevated from under the
lamina of thyroid cartilage
The inner perichondrium is incised posteriorly
and inferiorly
A septal elevator can be introduced via the
inferior margin of thyroid lamina and medial
pressure can be applied to assess the patient's
voice
If result is good then Gor-Tex can be inserted

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Insertion of Gor-Tex strips
1 cm wide strips of Gor-Tex dipped in Bacitracin
solution is introduced via the window created
Insertion is performed via the inferior margin of
thyroid lamina and delivered via the cartilage
window
Amount of Gor-Tex insertion depends on the
quality of voice

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Gor-Tex inserted

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Important to perform pre op
And post op video laryngoscopic
examination

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Thankyou