Long-term treatment outcome of type 1 thyroplasty using novel titanium medialization laryngoplasty implant combined with arytenoid adduction for unilateral vocal cord paralysis: single-arm interventional study at a single institution

Abstract

Objective: To evaluate the long-term treatment outcome of type 1 thyroplasty with novel rearrangeable titanium medialization laryngoplasty implant (TMLI) combined with arytenoid adduction (AA) for unilateral vocal cord paralysis (UVFP) in the authors' institution.

Methods: A total of 16 Japanese patients with UVFP who received type 1 thyroplasty using TMLI with arytenoid adduction was enrolled in this single-arm, non-randomized interventional study. The results of the auditory perceptual assessment, aerodynamic examination, acoustic measurement, and patient-based survey on these patients were evaluated preoperatively and at 3, 6, and 12 months postoperatively.

Results: Type 1 thyroplasty using TMLI with arytenoid adduction for our patient series presented significant improvements in maximum phonation time, mean flow rates, GRBAS scale, the Voice Handicap Index and the Voice-Related Quality of Life score over the 12-month postoperative period.

Conclusion: Type 1 thyroplasty using TMLI with arytenoid adduction was quite effective for obtaining satisfactory postoperative voice improvement without any surgical complication over the long-term period.

Keywords: arytenoid adduction; titanium medialization laryngoplasty implant; type 1 thyroplasty; unilateral vocal fold paralysis.

FIGURE 1

Titanium medialization laryngoplasty implant. The adjustment to achieve medialization is performed by molding the implant at a suitable site. The implant has the line applied a 105°/75° in the plate. (i) Handle. (ii) Medialization part. (a) This place adjusts the medialization of the vocal fold anteriorly. (b) Adjusting the width that carries out the medialization of the vocal fold. (c) This place adjusts the medialization of the vocal fold posteriorly. Abbreviations: AD, anterior depth; PD, posterior depth; W, width

FIGURE 2

Postoperative CT images in representative three cases: A, case 6; B, case 7; C, case 12

FIGURE 3

A, The significant improvement in MPT by surgery was observed over the 12‐month postoperative period; P < .001. B. The significant improvement in MFR by surgery was observed over the 12‐month postoperative period; P < .001. C, The significant improvement was observed over the 12‐month postoperative period, Black line/circle, G (P < .001); black line/square, R (P < .001); black line/triangle, B (P < .001); gray line/triangle, A (P = .489); gray line/diamond, S (P = .837). D, The significant improvement in VHI by surgery was observed over the 12‐month postoperative period; P < .001. E, The significant improvement in VRQOL by surgery was observed over the 12‐month postoperative period; P < .001. F, The improvement in Jitter by surgery observed over the 12‐month postoperative period; P = .205. G, The improvement in Shimmer by surgery was observed over the 12‐month postoperative period; P = .710. H, The change in NHR by surgery was observed over the 12‐month postoperative period; P = .846. H, The change in F0 by surgery was observed over the 12‐month postoperative period; P = .312. §, eight patients who were not able to receive acoustic examinations preoperatively due to their severe hoarseness