Operative Procedure of Anterior Commissure for Type II Thyroplasty.

OBJECTIVE: We reviewed the clinical anatomy of the anterior commissure and examined the effectiveness of a specialized spreader developed for optimal, efficient spreading of the thyroid cartilage in type II thyroplasty. STUDY DESIGN AND METHODS: The present study was a multicenter retrospective study of patients with spasmodic dysphonia who underwent a primary operation either before or after the introduction of a specialized spreader (in 2008 or 2014, respectively). In these patients, we examined the size of the titanium bridge used, the presence of perforation of the mucosa directly superior to the anterior commissure, and postoperative glottic findings. RESULTS: The sample comprised 39 and 40 patients who underwent surgery in 2008 and 2014, respectively. The mean size of the titanium bridge used during surgery was significantly smaller in 2014 (2.9 mm) than in 2008 (3.81 mm). Perforation of the laryngeal mucosa occurred in 13 patients in 2008 but occurred in only one patient in 2014. Based on glottic findings, spreading the thyroid cartilage using the specialized spreader was deemed to yield an effective glottic gap. CONCLUSIONS: In type II thyroplasty, the handling of the anterior commissure is the most important point. It is necessary to split the tendon and to spread the glottis while the tendon is joined with the cartilage. For this purpose, a specialized spreader was made. The use of a specialized spreader renders separation around the anterior commissure unnecessary, enabling minimally invasive spreading of the thyroid cartilage and thereby improving phonation.

Overall evaluation of effectiveness of type II thyroplasty for adductor spasmodic dysphonia.

OBJECTIVE/HYPOTHESIS: To assess the effectiveness of type II thyroplasty with a titanium bridge in adductor spasmodic dysphonia (AdSD). STUDY DESIGN: Retrospective chart review, patient response to a questionnaire on the ease of phonation and voice quality, and pre- and postoperative fiberoptic laryngoscope findings. SUBJECTS: Forty-one patients who underwent type II thyroplasty with a titanium bridge between December 2002 and December 2005 who have been followed for at least 12 months postoperatively. RESULTS: Six patients were male, and 35 were female. The voice was recorded before and at least 6 months after surgery. Initially, 97.6%, 61%, and 48.8% of the patients had a strangulated, interrupted, or tremulous voice, respectively. The mean ratings of strangulation, interruption, and tremor were calculated. The respective mean pre- and postoperative scores were 1.51 and 0.46 for strangulation, 0.76 and 0.05 for interruption, and 0.65 and 0.048 for tremor. In the postoperative questionnaire, 70% of the patients judged their voice as excellent and the remaining patients as improved to good or fair. CONCLUSIONS: Type II thyroplasty is a highly effective therapy for AdSD. The voice in AdSD may roughly be classified into strangulated, tremulous, and interrupted types. The outcome measures justify the continued treatment of AdSD with type II thyroplasty.

Bilateral vocal fold paralysis and adhesion in anterior spinal artery syndrome.

The purpose of this report is to present a rare case of anterior spinal artery syndrome (ASAS) in which there proved to be a combined lesion of paralysis and adhesion. A 26-year-old woman with a history of ASAS complained of difficulty of tracheal decannulation. In 1988, she was intubated and underwent tracheotomy because of respiratory muscle weakness, and she was decannulated in 1990. In 1998, she had cesarean delivery under general anesthesia, and postdelivery dyspnea necessitated tracheotomy again. On her first visit to us, endoscopic examination revealed bilateral vocal fold immobility at the midline without an apparent web. Direct laryngoscopy under general anesthesia revealed a posterior glottic adhesion and scarring, which were treated by excision of the scar and local steroid injection. The left vocal fold gradually regained mobility, permitting decannulation 3 months after treatment. This complicated vocal fold immobility was found to be due to adhesion and partial paralysis combined.

Type 2 thyroplasty for spasmodic dysphonia: fixation using a titanium bridge.

OBJECTIVE: In order to facilitate surgery for spasmodic dysphonia, i.e. type 2 thyroplasty, a device was designed to fix the incised edges of the thyroid cartilage firmly. MATERIAL AND METHODS: Various types and sizes of titanium bridge were developed for clinical use. RESULTS: The results of surgery for spasmodic dysphonia were satisfactory in all 10 cases in which the new titanium bridge was used. No complications have been encountered to date. CONCLUSION: Type 2 thyroplasty for spasmodic dysphonia was made easier to perform using the new titanium bridge, and more stable fixation of the reconstructed thyroid cartilage was achieved.

Surgical tips for type II thyroplasty for adductor spasmodic dysphonia: modified technique after reviewing unsatisfactory cases.

CONCLUSION: 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. OBJECTIVES: 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. PATIENTS AND 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.

Outcomes of type II thyroplasty for adductor spasmodic dysphonia: analysis of revision and unsatisfactory cases.

CONCLUSION: The factors responsible for the observed failures can be broken into two major groups: (1) a wrong indication and (2) an inadequate technique to achieve relief from an excessively tight glottal closure. The use of a titanium bridge in place of a silicone shim was found to be essential. Type II thyroplasty can relieve the symptoms of adductor spasmodic dysphonia (AdSD) when implemented with a modern technique using titanium bridges. OBJECTIVES: To identify the factor or factors that necessitated revision surgery in type II thyroplasty for AdSD, detailed analytical examinations were made of individual cases with unsatisfactory outcomes. PATIENTS AND METHODS: A retrospective analysis of a case series with follow-up periods of 2-5 years. RESULTS: Ninety AdSD patients underwent type II thyroplasty. The results in one patient were limited because a pathological mechanism other than AdSD was also involved. One patient, a singer, who wanted a more intense voice for singing was dissatisfied with the results. In three patients, the material used for fixation was inadequate. In two other patients, the method of application of the fixative material was found to be insufficient as it did not include both the upper and lower sides.

Avaliaçäo e tratamento da incompetência velofaríngea: tendências atuais no Japäo / Evaluation and treatment of velopharyngeal incompetence: present trends in Japan

The present article describes the approach developed at the Cleft Palate Clinic of Kyoto University Hospital, aiming at introducing assessment and treatment for velopharyngeal function currently in use in Japan. A multi-view approach with the main emphasis given to the fluorocideography and to the nasopharyngofiberscopy permits accurate analysis and evaluation of dynamic velopharyngeal gesture and facilitates the selection of adequated treatment. The article describes the surgical treatment, the speech therapy procedures, and presentes a case study reporting the therapeutic approach to the articulation disorders combined with sligth velopharyngeal incompetence