title: A-P positioning of medialization thyroplasty in an excised larynx model.
abstract: OBJECTIVE
  Posterior positioning of medialization thyroplasty provides the best acoustic and aerodynamic outcomes.
  
  
  METHODS
  Ex vivo excised canine larynx.
  
  
  METHODS
  Unilateral thyroplasty windows were cut in the thyroid cartilages of 10 excised canine larynges. Each larynx was mounted on an artificial lung and the vocal fold opposite the thyroid window was adducted by medializing its arytenoid cartilage. Then, medialization thyroplasty was simulated with a probe placed anterior, central, and posterior in the thyroid window. The glottal area, airway reduction, medialization force, phonation threshold pressure and flow, aerodynamic power, intensity, efficiency, jitter, shimmer, and signal-to-noise ratio (SNR) were measured at each medialization position.
  
  
  RESULTS
  Posterior medialization probe placement minimized the glottal area, provided the best voice as determined by perturbation measures and SNR, reduced the work of phonation, and increased efficiency. Anterior and middle probe placement minimized the work of phonation but provided only modest gains in sound quality and decreased sound intensity. Medializing the vocal fold with posterior probe placement required twice as much force as central and anterior probe placement.
  
  
  CONCLUSIONS
  The results suggest that posterior medialization provides the greatest improvement in acoustic parameters and efficiency in patients who can tolerate the airway reduction. Middle and anterior medialization can decrease work of phonation, but in this experiment objective improvement in sound quality was limited. Subtle changes in displacement shim contour, especially in middle and anterior locations, have a substantial impact on voice outcome, affirming the value of intraoperative voice assessment.
authors.affiliation: Department of Surgery, Division of Otolaryngology Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Czerwonka
authors.forename: Charles N
authors.initials: CN
authors.lastname: Ford
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Machi
authors.forename: Glen E
authors.initials: GE
authors.lastname: Leverson
authors.forename: Jack J
authors.initials: JJ
authors.lastname: Jiang
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004285:Dogs; D007830:Larynx; D019651:Plastic Surgery Procedures / Q000379:methods*; D013957:Thyroid Cartilage / Q000601:surgery*; D014833:Voice Quality