Silastic medialization and arytenoid adduction: the Vanderbilt experience. A review of 116 phonosurgical procedures.
From April 1987 to April 1992, 116 phonosurgical procedures were performed to treat glottal incompetence. The initial numbers of these surgical procedures included the following: 29 primary Silastic medializations, 3 primary Silastic medializations with arytenoid adduction, 53 secondary Silastic medializations, 4 secondary Silastic medializations with arytenoid adduction, and 11 bilateral Silastic medializations. These procedures are useful in treating unilateral true vocal cord paralysis, scarring, bowing, or paresis, as well as bilateral true vocal cord bowing. Of the initial 100 patients, 16 later underwent a revision with either a larger implant's being placed or an arytenoid adduction. Primary Silastic medialization is the placement of an implant under general anesthesia in the same surgical setting in which laryngeal innervation is sacrificed. Secondary Silastic medialization is the placement of an implant under local anesthesia for a preexistent vocal cord malfunction. In either case, overall voice results for unilateral paralysis are very good. Primary Silastic medialization significantly decreases the postoperative rehabilitation period in skull base patients because of the immediate postoperative glottal competence and decreased use of perioperative tracheotomy. Bilateral implants yielded good results in 6 patients with presbylaryngis, but 6 other patients with bowing from other causes experienced only moderate improvement in speech quality. There were no implant extrusions; however, 1 implant was removed secondary to a persistent laryngocutaneous fistula in a patient who had previously undergone laryngeal irradiation. This was the only complication in this series.
Department of Otolaryngology, Vanderbilt Medical Center, Nashville, TN 37232-2559.
J L
JL
Netterville
R E
RE
Stone
E S
ES
Luken
F J
FJ
Civantos
R H
RH
Ossoff
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000772:Anesthesia, Local; D005260:Female; D005931:Glottis / Q000503:physiopathology; D006801:Humans; D007817:Laryngeal Cartilages / Q000601:surgery; D007821:Laryngeal Muscles / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D012826:Silicone Elastomers; D012828:Silicones / Q000627:therapeutic use*; D013536:Suture Techniques; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000601:surgery*; D014833:Voice Quality
D012826:Silicone Elastomers; D012828:Silicones