title: Clinical experience with Gray's minithyrotomy procedure.
abstract: OBJECTIVE
  Endoscopic approaches for submucosal vocal fold surgery may limit the surgeon's ability to release scars or to precisely implant filler material such as fat. In 1999, Gray et al described the "minithyrotomy" approach to this region. Technical aspects of this important new technique, clinical indications, and early results are reviewed.
  
  
  METHODS
  We performed a retrospective review and compiled the data of the office records, clinical notes, and videostroboscopic examinations of all of the four authors' patients who underwent this procedure.
  
  
  RESULTS
  Twenty-one patients underwent 22 minithyrotomy procedures for vocal fold scarring (6), lateralizing scar following polytetrafluoroethylene removal or trauma (5), scar with radiation fibrosis (2), sulcus vocalis (2), or presbylarynx or bowing (6) - bilaterally in 14 operations and unilaterally in 8. There were 13 male patients and 8 female patients, with a mean age of 58.3 years (range, 22 to 87 years). The mean follow-up was 9.1 months (range, 1 to 46 months). After submucosal vocal fold exploration, autologous fat was implanted in 20 of the 21 patients. Postoperative videostroboscopy demonstrated improved mucosal pliability in 19 cases and improved glottal closure in 20 cases. Most patients noted voice improvement. Complications were minimal.
  
  
  CONCLUSIONS
  Gray's minithyrotomy is a highly effective approach for treating vocal fold scar processes, bowing, sulcus vocalis, and, potentially, other conditions.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri 63110, USA.
authors.forename: Randal C
authors.initials: RC
authors.lastname: Paniello
authors.forename: Lucian
authors.initials: L
authors.lastname: Sulica
authors.forename: Siddarth M
authors.initials: SM
authors.lastname: Khosla
authors.forename: Marshall E
authors.initials: ME
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D049489:Stroboscopy; D016896:Treatment Outcome; D014827:Vocal Cords / Q000473:pathology / Q000601:surgery*