Type 1 Thyroplasty - Silastic

Vocal fold paralysis with glottic incompetence

History of previous external beam radiation is a relative contraindication due to the increased risk of implant extrusion.

Anesthetic type: local anesthesia and monitored anesthesia care. A flexible nasolaryngoscope is suspended in the patients nose throughout the case to visualize the larynx. The patient is typically positioned supine, with a shoulder roll, in lawnchair position with their arms tucked at their side.

In office laryngoscopy and voice evaluation should be performed pre-operatively. Anti-coagulation and anti-platelet agents should be help peri-operatively. Pre-op antibiotics and airway dose steroids should be given prior to incision.

The incision is made a the mid thyroid cartilage level with flap raised up the thyroid notch and down to the cricoid. When placing the implant, removing the inner perichondrium is key to allowing precise vocal fold medialization.

Vocalization during implant carving and placement allows for "tuning" of the implant. However, type 1 thyroplasty alone is best for the membranous larynx. It can be combined with arytenoid adduction if needed to close the posterior glottis.

Some individuals may be unable to tolerate the procedure under local and monitored anesthesia care. An LMA can be placed; however, the surgeon looses the ability to "tune" the implant.

Endolaryngeal hematoma can cause stridor and airway obstruction. Meticulous hemostasis is important. Visualization of the larynx with the endoscope can help prevent misplacement of the implant too superior, too inferior, or too anterior. Subsequent intubation can cause dislodgement of the implant. Implant extrusion can also occur, especially in the setting of previous external beam radiation.

Spring and Elsevier royalties

Silastic Medialization Laryngoplasty for Unilateral Vocal Fold Paralysis. In Rosen C and Simpson B eds. Operative Techniques in Laryngology. pgs. 241-250. Springer