Complications of Type I Thyroplasty and Arytenoid Adduction

TLDR

Unilateral vocal fold paralysis causes significant morbidity from impaired speech, swallowing, and airway protection, but the benefits of type I thyroplasty with arytenoid adduction outweigh the small risk of complications. The study retrospectively reviewed 237 patients undergoing unilateral vocal fold medialization, with 98 receiving type I thyroplasty alone and 96 receiving type I thyroplasty plus arytenoid adduction. Patients receiving type I thyroplasty with arytenoid adduction had longer operative times and hospital stays but similar overall symptom improvement (93–94%) and only a slightly higher, non‑significant complication rate (14% vs.

Abstract

Unilateral vocal fold paralysis resulting in glottal incompetence can cause significant morbidity attributable to impaired speech, swallowing, and ability to protect the airway. Type I thyroplasty in combination with arytenoid adduction is a proven technique for medialization of the paralyzed vocal fold but must be evaluated in light of potential complications following laryngeal framework surgery.The charts of 237 patients who underwent unilateral vocal fold medialization surgery between July 1, 1991, and August 30, 1999, at a tertiary care cancer referral center were retrospectively reviewed.There were 98 cases of type I thyroplasty alone and 96 cases of type I thyroplasty with arytenoid adduction. The two groups had similar patient characteristics. Mean time of surgery (45 vs. 73 min, P <.0001) and length of hospital stay (1.1 vs. 1.8 d, P <.0001) were increased when arytenoid adduction was performed. Overall improvement of symptoms was similar in both groups (93%-94%), but posterior glottic closure appeared subjectively improved when arytenoid adduction was used (P =.0054). Overall complication rates were slightly higher in the arytenoid adduction group (14% vs. 19%), primarily because of transient vocal fold edema and wound complications (9 vs. 19 cases), but the increase was not statistically significant (P =.1401). Complications warranting medical or surgical intervention occurred in 8% of cases. Two patients who underwent type I thyroplasty with arytenoid adduction required tracheotomy as a consequence of postoperative complications. The three patients who had extrusion of the implant underwent type I thyroplasty alone.Using the appropriate technique, the potential benefits of improved glottic function following type I thyroplasty with arytenoid adduction outweigh the small risk of significant complications observed.