title: Surgical tips for type II thyroplasty for adductor spasmodic dysphonia: modified technique after reviewing unsatisfactory cases.
abstract: CONCLUSIONS
  Use of the titanium bridge, both at the top and bottom corners of the incised thyroid cartilage, is essential for success. Most importantly, these procedures should be done with minimal damage to the tissues involved, using fine instruments.
  
  
  OBJECTIVE
  Type II thyroplasty that aims at lateralization of the vocal folds for spasmodic dysphonia is a type of surgery that requires utmost surgical caution, because of the extremely delicate site for surgical intervention, critically sensitive adjustment, and difficult procedures to maintain the incised cartilages in a correct position.
  
  
  METHODS
  By means of a postoperative questionnaire and examinations, analyses were made of the relation in each case between the detailed surgical records and the outcomes in terms of subjective complaints, vocal features, and laryngeal as well as aerodynamic findings.
  
  
  RESULTS
  It was found that surgical failures or unsatisfactory results arise most frequently from certain clear mechanical faults. The critical procedures that most affected the results included: (1) incision and separation of the thyroid cartilage at the midline; (2) adjustment of separation width for optimal voice; (3) cartilage-perichondrium separation for holding an appropriate titanium bridge; and (4) installation and fixation of titanium bridges.
authors.affiliation: Kyoto Voice Surgery Center, Kyoto, Japan. nobyisshiki@yahoo.co.jp
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Isshiki
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Sanuki
mesh_terms: D055154:Dysphonia / Q000175:diagnosis* / Q000503:physiopathology / Q000517:prevention & control*; D017408:Guidelines as Topic; D006801:Humans; D007823:Laryngeal Nerves / Q000503:physiopathology; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013961:Thyroid Gland / Q000601:surgery*; D014833:Voice Quality