title: Revision Transcervical Medialization Laryngoplasty for Unilateral Vocal Fold Paralysis.
abstract: OBJECTIVE
  To identify patterns of failure following transcervical medialization laryngoplasty for unilateral vocal fold paralysis and describe indications and revision techniques for optimal vocal outcomes.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Thirty-nine consecutive patients between January 2005 and April 2014 undergoing transcervical revision of failed primary medialization laryngoplasty were identified. Demographics, etiology, stroboscopic assessment, and surgical techniques were recorded. Patient self-assessment using the Voice-Related Quality-of-Life (VRQOL) questionnaire and objective acoustic and aerodynamic assessments performed pre- and postoperatively were analyzed using t tests for paired comparisons.
  
  
  RESULTS
  Thirty-nine patients underwent 48 transcervical revision surgeries. Median follow-up was 14.6 months from time of final revision surgery. Indications included anterior glottic incompetence (38/48, 79%), posterior glottic incompetence (20/48, 42%), glottic overclosure (8/48, 17%), and/or decreased phonatory pliability (12/48, 25%). A combination of findings was present in 21 (44%) surgeries. Revision techniques included either anterior augmentation, arytenopexy, and cricothyroid subluxation (alone or in combination) in 46 of 48 (96%) patients or partial implant removal alone in 2 patients. Seven patients (18%) required multiple revisions. A complete set of voice parameters was available for 22 patients, and statistically significant improvements included VRQOL scores, fundamental frequency in females, jitter, noise-to-harmonic ratio, and mean airflow rate.
  
  
  CONCLUSIONS
  Patterns of failure in patients with suboptimal phonatory function after transcervical medialization laryngoplasty included persistent glottic incompetence, glottic overclosure, and decreased vocal fold pliability. Revision transcervical medialization surgery, guided by individualized consideration of vocal fold position and surface pliability, can improve phonatory outcomes.
authors.affiliation: Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Noah P
authors.initials: NP
authors.lastname: Parker
authors.affiliation: Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Anca M
authors.initials: AM
authors.lastname: Barbu
authors.affiliation: Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Hillman
authors.affiliation: Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Zeitels
authors.affiliation: Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA Burns.James@MGH.Harvard.edu.
authors.forename: James A
authors.initials: JA
authors.lastname: Burns
mesh_terms: D005260:Female; D006801:Humans; D058753:Laryngoplasty / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009333:Neck; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D017211:Treatment Failure; D014826:Vocal Cord Paralysis / Q000473:pathology / Q000601:surgery*
keywords: dysphonia; laryngoplasty; paralysis; revision; vocal cord