Endoscopic Management of Extruding Medialization Laryngoplasty Implants

Abstract

Endoscopic removal appears to be a safe, effective, and even preferred alternative to external transcervical removal in selected cases of extruding implants.

Medialization Laryngoplasty With Gore-Tex: An Animal Study

“…Three cases of extrusion after medialization have been reported in the literature to date, but in these studies the authors had incised the inner perichondrium and implanted the material medial to the inner perichondrium, and this may be the reason for the extrusion. 31,34 Our findings showed that GoreTex is a stable and safe implant material in the larynx as it is placed lateral to the intact inner perichondrium through the thyroid cartilage window. The Gore-Tex implant is soft and easy to handle.…”

“…32,33 Halum et al reported two cases of Gore-Tex extrusion. 34 However, there was not enough information about the surgical technique. According to a case report, Gore-Tex implantation does not result in a significant granulomatous reaction in the human larynx over a 13-month period.…”

Case of migrated Gore-Tex implant following external thyroplasty

“…Extruded implants are more obvious and can be managed endoscopically 2. This case also demonstrates the value of high-resolution CT scans with laryngeal reconstructions as part of preoperative planning.…”

Extrusion of Gore-tex implant after medialization thyroplasty

“…They thought that the possible reason of extrusion was removel of the inner pericondrium and impossibility of locking the implant to the window made in the thyroid cartilage lamina. Halum et al [8] reported two cases, and suggested that implant extrusion is related to lack of surgeon experience and improper implant placement. In the window placement technique, great attention must be paid in order not to cause granulation tissue in the transepithelial part of the inner perichondrium during the blunt dissection and palcement of the material.…”

“…[8] Endoscopic removal may be preferred in cases associated with extrusion into the airway. In our case, we used an external approach as edema did not allow the performance of the endoscopic approach.…”