Gray Minithyrotomy

Vocal fold scar, Sulcus vocalis, Mild vocal fold bowing, especially when associated with age-related alterations in lamina propria thickness and pliability

General anesthesia
Use as small an endotracheal tube as possible: 5.0 for females, 5.5 for males
IV steroids
Primary surgeon will be more comfortable working from the patient�¢ï¿½ï¿½s right if right handed and vice versa
Suspension laryngoscopy equipment
0, 30, 70-degree endoscopes
22-gauge needle
Powered drill with 3-mm cutting burr
Mastoid curette
Tympanoplasty tray with Duckbill and Gimmick elevators, blunt probes, Belluci scissors (straight and angled), Alligator forceps

Laryngoscopy with stroboscopy to show scar/sulcus vocalis

- Suspension laryngoscopy is performed to expose the entire glottis and to be visualized with a 0-degree endoscope
- 2-3 cm incision is centered over the prow of the thyroid cartilage and dissection is carried out in the midline to the anterior face of the thyroid cartilage
- Fat is harvested from the area of the incision, 1-2 ml per vocal fold
- Under endoscopic visualization, a 22-gauge needle is used to identify the midline/anterior commissure

- Risks of laryngoscopy - injury to teeth, lips, tongue, gums, persistent tongue numbness/alteration in taste
- Vocal fold epithelium perforation (may be unavoidable in cases of severe scar)
- Pinhole perforations do not require that the procedure be terminated
- Small perforations may be patched using a piece of perichondrium from the outside of the thyroid cartilage
- In the presence of a large tear, the procedure is best left abandoned

- Suboptimal results
- Fat implantation does not restore normal voice in most cases as it is not a perfect replacement for the lamina propria

- Risks of laryngoscopy - injury to teeth, lips, tongue, gums, persistent tongue numbness/alteration in taste
- Vocal fold epithelium perforation (may be unavoidable in cases of severe scar)
- Pinhole perforations do not require that the procedure be terminated
- Small perforations may be patched using a piece of perichondrium from the outside of the thyroid cartilage
- In the presence of a large tear, the procedure is best left abandoned

- Suboptimal results
- Fat implantation does not restore normal voice in most cases as it is not a perfect replacement for the lamina propria

Chapter 48, The Gray Minithyrotomy for Vocal Fold Scar/Sulcus Vocalis Operative Techniques in Laryngology, Clark A. Rosen and C. Blake Simpson. 2008.