Type I thyroplasty: A safe outpatient procedure

Abstract

Objectives/Hypothesis: Overnight hospitalization is routinely advocated following type I thyroplasty (TP) because of concerns for airway compromise. Hospitalization increases cost and patient inconvenience, and may not necessarily be appropriate. This study evaluated complications following surgery and identified predictors for same to assess which patients benefit most from hospitalization.Study Design: Retrospective chart review.Methods: A study was conducted on patients who underwent TP with or without arytenoid repositioning procedures between June 2008 and March 2017. The demographic data of the subjects, characteristics, etiology of glottic insufficiency, interventions performed, and subsequent complications were evaluated.Results: Of 147 patients reviewed, 100 underwent TP alone, 41 underwent TP with arytenoid adduction, and six patients underwent TP with adduction arytenopexy. Iatrogenic vocal fold paralysis was the most common indication. Major complications, which included transient airway compromise and hematoma requiring reoperation, occurred in 7% of patients. Revision surgery and thyroplasty combined with arytenoid repositioning maneuvers were associated with increased risk of major complications.Conclusions: In general, TP is a safe procedure, with a major complication rate that is lower than that of outpatient thyroidectomy. Overnight hospitalization should be considered in patients undergoing revision surgery and in those requiring concurrent arytenoid repositioning procedures.

Safety of Outpatient Type 1 Thyroplasty

“…The only complications of nonobstructive hematoma and implant extrusion occurred in patients on anticoagulation and in patients with poor implant placement or prior radiation therapy, respectively. 13,15 In our series, there was a one case of implant extrusion due to persistent infection and granulation tissue deposition at the site of primary surgery.…”

“…The reported complication rate for patients undergoing type 1 thyroplasty is between 7% and 20%. 12,13,15,17,18,[19][20][21][22] However, our study found a major complication rate of 5.6% with no long-term morbidity or mortalities. There were 4 cases of airway complications that were considered major; however, none of the patients required intubation or tracheostomy.…”

“…17 Many studies advocate for risk stratification based on patient comorbidities to determine whether a patient may require postoperative observation to prevent major complications, specifically airway compromise. 15,[18][19][20] The 2 operating surgeons (M.B. and J.S.)…”

Predictors of Increased Surgical Drain Output following Type I Thyroplasty for Glottic Insufficiency

“…However, surgical practices often vary by provider and institution. For instance, in an institutional sample of 100 patients undergoing type I thyroplasty reported by Julapan et al, 19 patients received a surgical Penrose drain and 80 patients did not 2 . In contrast, all of the patients at our institution received a surgical drain after type I thyroplasty from 2014 to 2019.…”

“…Glottic insufficiency is characterized by incomplete closure of the true vocal cords during phonation, leading to symptoms of dysphonia, vocal fatigue, and occasionally dysphagia or aspiration 1 . Type I thyroplasty has long been considered the gold standard for long‐term surgical management of glottic insufficiency 2,3 . It involves medialization of the true vocal cord with an alloplastic implant 4 .…”