Medialization thyroplasty for voice restoration after transoral cordectomy

Fourteen dysphonic patients who had previously undergone total or extended cordectomy underwent medialization thyroplasty. A minimum delay of 6 months was respected to allow the spontaneous “neocord” formation, to evaluate the voice recovery achieved by speech therapy alone and to avoid an undiagnosed early recurrence. Surgery was performed under general anaesthesia, using a laryngeal mask, because undermining the fibrous tissue at the inner side of the thyroid ala is a prolonged and difficult procedure. This step was essential to ensure an easy placement of the implant and to avoid tearing the fibrous tissue, with subsequent risk of implant extrusion. Visual control of the implant implementation was obtained by flexible videoendoscopy. The Montgomery^® implant system (Boston, Westborough, MA) was used for the majority of the cases. Hand-made modified Montgomery implants or Gore-tex^® were used in case of extended scarring or peculiar anatomic defect. The voice assessment showed a decrease of the VHI score from 50.5 to 39.4; a decrease of G from 2.4 to 2; an increase of maximum phonation time (MPT) from 6.2 to 7.3 s; a decrease of the maximum fundamental frequency (Fo-high) from 338.7 to 242.4 Hz and a decrease of the phonation quotient from 1,144.9 to 544.9 ml/s. The lower intensity (I-low) remained unchanged, from 60 to 58 dB. Statistically significant improvement was noted only for VHI and G grading. A decrease of the voice efforts and fatigue were noticed by all the patients.