title: External vocal fold medialization in patients with recurrent nerve paralysis following cardiothoracic surgery.
abstract: OBJECTIVE
  Recurrent laryngeal nerve injury is a possible complication following cardiothoracic surgery. Due to insufficient glottal closure, dysphonia and dysphagia with aspiration may occur. The purpose of the study was to outline the effect of vocal fold medialization thyroplasty on voice, swallowing and breathing impairments.
  
  
  METHODS
  Between 1999 and 2001, medialization thyroplasty using the titanium implant (TVFMI) according to Friedrich was performed in 14 patients with postoperative left-sided recurrent nerve paralysis (five female and nine male patients, mean age 64 years) by an external approach. Previous surgical procedures comprised six lobectomies (combined with resection and replacement of the subclavian artery in one case), two pneumonectomies, one resection of a schwannoma in the aortopulmonary window, two replacements of the descending aorta, one aortocoronary bypass procedure (with LIMA), and two esophageal resections using Akiyama technique, respectively. Before and after thyroplasty, the patients underwent an otolaryngological/phoniatric examination including videostroboscopy, voice sound analysis, voice range profile measurement, pulmonary function testing, and in selected cases videofluoroscopy of swallowing.
  
  
  RESULTS
  Following thyroplasty, all patients reported on subjective improvement of voice, swallowing and breathing functions. Videostroboscopy revealed an improved glottal closure (six complete, six with posterior gap). All voice related parameters (e.g. roughness, breathiness, hoarseness, maximum sound pressure levels of the singing and shouting voices) were significantly improved.
  
  
  CONCLUSIONS
  Due to potential risk of recurrent nerve alteration in left-sided intrathoracic procedures, a preoperative and postoperative laryngoscopic examination is recommended. The external medialization of the vocal folds can be regarded as an excellent method for improvement of voice, swallowing and breathing, in particular, when the quality of life is impaired due to persistent recurrent nerve paralysis.
authors.affiliation: Section of Phoniatrics-Logopedics, Department of Otorhinolaryngology, General Hospital, University Hospital of Vienna, Vienna, Austria. berit.schneider@akh-wien.ac.at
authors.forename: Berit
authors.initials: B
authors.lastname: Schneider
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bigenzahn
authors.forename: Adelheid
authors.initials: A
authors.lastname: End
authors.forename: Doris-Maria
authors.initials: DM
authors.lastname: Denk
authors.forename: Walter
authors.initials: W
authors.lastname: Klepetko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011446:Prospective Studies; D019736:Prostheses and Implants; D019616:Thoracic Surgical Procedures; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000601:surgery*; D014827:Vocal Cords / Q000601:surgery*; D014833:Voice Quality