Voice Outcome after Gore-Tex Medialization Thyroplasty

Abstract

Introduction Although medialization thyroplasty utilizing Gore-Tex (Gore and Associates, Newark, Delaware, United States) has been discussed in the literature, few reports have assessed voice quality afterward, and they did not use a full assessment protocol. Objective To assess the improvement in voice quality after medialization thyroplasty utilizing Gore-Tex in patients with glottic insufficiency of variable etiology. Methods Eleven patients with glottic insufficiency of different etiologies that failed compensation were operated by type 1 thyroplasty utilizing Gore-Tex. Pre- and postoperative (1 week, 3 months, and 6 months) voice assessment was done and statistical analysis was performed on the results. Results In all postoperative assessments, there was significant improvement in the grade of dysphonia (p < 0.004) and highly significant reduction in the size of glottic gap and prolongation of maximum phonation time (p < 0.0001). The difference in voice parameters in the early (1 week) and the late (3 and 6 months) postoperative period was not significant. None of the patients developed stridor or shortness of breath necessitating tracheotomy, and there was no implant extrusion in any patient during the study period. Conclusion Gore-Tex medialization provides reliable results for both subjective and objective voice parameters. It leads to a satisfactory restoration of voice whatever the etiology of glottic incompetence is. This technique is relatively easy and does not lead to major complications. Further studies with larger number of patients and more extended periods of follow-up are still required to assess the long-term results of the technique regarding voice quality and implant extrusion.

Tiroplastía de medialización con Gore-Tex®: Experiencia de 8 años en Hospital Clínico de la Universidad de Chile

“…Gore-tex ® fue creado en el año 1960, las primeras aplicaciones fueron en la cirugía vascular. Desde esa fecha se ha descrito este material como semiporoso, con una excelente integración con los tejidos, con mínima inflamación de éstos, bajo índice de extrusión y fácil de remover si es necesario 7 . El material es altamente compatible y fácil de manipular, el procedimiento de medialización es rápido y técnicamente no muy Tabla 2.…”

“…De éstas la más frecuente es la parálisis de cuerda vocal unilateral (PCVU), que no se recupera en forma espontánea 7 . La PCVU puede ser causada por una lesión del nervio vago a cualquier nivel, por lesión del núcleo ambiguo, del vago propiamente tal o del recurrente laríngeo.…”

Sex‐based outcomes in type I thyroplasty for nonparalytic glottic incompetence

“…These physical properties have led to its increased use in cases of nonparalytic GI. Gore‐Tex medialization thyroplasty (GMT) has demonstrated improvement in subjective and perceptual phonatory outcomes in addition to objective aerodynamic parameters for nonparalytic GI …”

“…Despite these well‐accepted differences, treatment outcomes are rarely reported by sex. Whereas breakdown of patients by sex or gender is typically provided in most published reports of medialization thyroplasty outcomes, only two prior studies have analyzed post‐treatment outcomes of medialization thyroplasty by sex in very specific patient populations . A separate assessment of voice outcomes by sex following GMT is fundamentally important for preoperative counseling and for tailoring patient expectations appropriately.…”

Excised larynx evaluation of subthyroid cartilage approach to medialization thyroplasty

“…It can lead to a breathy, hoarse voice and also impact swallowing and breathing function . Many surgical treatment options have been proposed including type I medialization thyroplasty, as described by Isshiki et al Several different implant materials and techniques have been proposed, and the use of Gore‐Tex material and the creation of a thyroid cartilage window for approach have been effective and commonly reported . This transthyroid (TT) cartilage approach has the benefit of direct access for implant insertion, but can incur difficulties due to window creation such as increased dissection time, wider exposure, and risk of cartilage fracture in patients with ossified cartilage .…”