Operative Mediofixation of the Vocal Cord in Complete Unilateral Paralysis

Arytenoid adduction as an adjunct to type I thyroplasty for unilateral vocal cord paralysis

“…5 Meurman 10 initially described the concept of vocal cord medialization via an external approach, but it was Isshiki 4 who popularized this approach. Isshiki described four thyroplasty procedures: the type I technique provides lateral compression to the paralyzed vocal cord, attempting to place it in midline position to allow for compensation from the contralateral mobile vocal cord.…”

Arytenoid adduction as an adjunct to type I thyroplasty for unilateral vocal cord paralysis

“…1,2 However, Teflon use is associated with long-term formation of granulomas and inconsistent results and is difficult to teach, due to the poor visualization obtained through a laryngoscope. 5 Meurman 10 initially described the concept of vocal cord medialization via an external approach, but it was Isshiki 4 who popularized this approach. Isshiki described four thyroplasty procedures: the type I technique provides lateral compression to the paralyzed vocal cord, attempting to place it in midline position to allow for compensation from the contralateral mobile vocal cord.…”

One hundred years of external approach medialisation thyroplasty

“…One of the very earliest attempts was by Seiffert in 1942, who utilized a piece of cadaveric rib cartilage implanted through a hole in the thyroid cartilage to medialize the vocal cord (33) . Meurman published a series of 15 cases in 1952, where cartilage taken from the costal rib was implanted via an external approach between the thyroid cartilage and the inner perichondrium to place a paralyzed vocal cord into a median position (35) . A similar technique was devised by Opheim in 1955, who instead used an incised piece of the thyroid cartilage itself, inserted via an external incision at the level of the vocal cords in the inner perichondrium (36) ; however, these techniques and others which involved direct intervention on the soft tissue immediately lateral to the vocal cord led to post-operative oedema, which often required a tracheotomy (22) .…”

“…Payr 1 (1915) described a U-shaped incision made in the thyroid cartilage at the level of the vocal folds, which is displaced inwards to medialise the underlying vocal fold. Meurman 35 (1952) reported splitting the anterior angle of the thyroid cartilage, avoiding damage to the perichondrium, and making a pocket for the cartilage implant between the perichondrium and the inner side of the thyroid ala. Opheim 36 (1955) described splitting the thyroid cartilage along the anterior midline using a small electric saw, avoiding damage to the inner perichondrium. A horizontal incision was made through the inner perichondrium at the level of the vocal folds, through which a small pouch was formed for the cartilage implant.…”