Long-term result of the new endoscopic vocal fold medialization surgical technique for laryngeal palsy.
OBJECTIVE
The conventional surgical method for a case of unilateral laryngeal nerve paralysis with large glottal gap requires an external cervical incision. In the present study, we developed an endoscopic technique of vocal fold medialization that can make the external incision unnecessary. This procedure of autologous transplantation of fascia into the vocal fold (ATFV) was developed for the successful treatment of unilateral laryngeal nerve paralysis. However, the method seemed to be effective only for patients with a relatively mild glottal gap.


METHODS
In the present study, we modified the method of medialization using the ATFV technique to obtain effective closure of a large glottal gap. To overcome this difficulty, an attempt was made to extend the site of transplantation more posteriorly so as to adduct the vocal process of the arytenoid cartilage in the body of the vocal fold.


RESULTS
This new technique was applied to eight cases of patients with unilateral laryngeal paralysis with severe dysphonia. None of the patients showed any evidence of falling off of the graft. Elongation of the maximum phonation time and a decrease in airflow rate during phonation were obtained with improvement in voice quality in all patients 1 year after the surgery.


CONCLUSIONS
This method, with its less invasive approach, proved to be useful for the treatment of large glottal gap due to unilateral laryngeal nerve paralysis.
Nishiyama
Koichiro
K
Department of Otorhinolaryngology, Kitasato University School of Medicine, Kanagawa, Japan. nishiya@khaki.plala.or.jp
Hirose
Hajime
H
Masaki
Takashi
T
Nagai
Hiromi
H
Hashimoto
Daimon
D
Usui
Daisuke
D
Yao
Kazuo
K
Tsunoda
Koichi
K
Okamoto
Makito
M
D000368:Aged; D004724:Endoscopy; D005205:Fascia / Q000637:transplantation; D005260:Female; D006801:Humans; D061224:Laryngeal Nerve Injuries; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000601:surgery*; D014827:Vocal Cords / Q000601:surgery*